Document:

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                                                                                                                     EXHIBIT (10)(b)

<S>                                            <C>                                                                     <C>
  Complete and return to:                      THE UNITED STATES LIFE INSURANCE COMPANY
  The United States Life                            In the City of New York ("USL")
   Insurance Company                           390 Park Avenue . New York, NY 10022-4684
 In the City of New York                                VARIABLE UNIVERSAL LIFE
 P.O. Box 4728 Dept. L                            INSURANCE SUPPLEMENTAL APPLICATION
Houston, Texas 77210-4728  (This supplement must accompany the appropriate application for life insurance.)
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                                                  PART 1.  APPLICANT INFORMATION
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Supplement to the application on the life of _____________________________________________________, dated__________________________.

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                                              PART 2.  INITIAL ALLOCATION PERCENTAGES
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Investment Options: In the "Premium Allocation" column, indicate how each premium received is to be allocated. In the "Deduction
Allocation" column, indicate which investment options are to be used for the deduction of monthly account charges. Total allocations
in each column must equal 100%. Use whole percentages only.

                                            PREMIUM   DEDUCTION                                                PREMIUM    DEDUCTION
                                           ALLOCATION ALLOCATION                                              ALLOCATION  ALLOCATION
                                           ---------- ----------                                              ----------  ----------
USL Declared Fixed Interest Account (148)    _______% _______%    NEUBERGER BERMAN ADVISERS MANAGEMENT TRUST
AIM VARIABLE INSURANCE FUNDS                                      Mid-Cap Growth Division (184)                  _______%  _______%
AIM V.I. International Equity Division (150) _______% _______%    PIMCO VARIABLE INSURANCE TRUST
AIM V.I. Value Division (151)                _______% _______%    PIMCO Real Return Bond Division (186)          _______%  _______%
AMERICAN CENTURY VARIABLE PORTFOLIOS, INC.                        PIMCO Short-Term Bond Division (185)           _______%  _______%
VP Value Division (166)                      _______% _______%    PIMCO Total Return Bond Division (187)         _______%  _______%
AYCO SERIES TRUST                                                 PUTNAM VARIABLE TRUST
Ayco Growth Division (250)                   _______% _______%    Putnam VT Diversified Income Division (161)    _______%  _______%
CREDIT SUISSE WARBURG PINCUS TRUST                                Putnam VT Growth and Income Division (162)     _______%  _______%
Small Company Growth Division (190)          _______% _______%    Putnam VT Int'l Growth and Income
DREYFUS INVESTMENT PORTFOLIOS                                       Division (163)                               _______%  _______%
MidCap Stock Division (251)                  _______% _______%    SAFECO RESOURCE SERIES TRUST
DREYFUS VARIABLE INVESTMENT FUND                                  Equity Division (164)                          _______%  _______%
Quality Bond Division (156)                  _______% _______%    Growth Opportunities Division (165)            _______%  _______%
Small Cap Division (155)                     _______% _______%    THE UNIVERSAL INSTITUTIONAL FUNDS, INC.
FIDELITY VARIABLE INSURANCE PRODUCTS FUND                         Equity Growth Division (159)                   _______%  _______%
VIP Asset Manager Division (255)             _______% _______%    High Yield Division (160)                      _______%  _______%
VIP Contrafund Division (254)                _______% _______%    VALIC COMPANY I
VIP Equity-Income Division (252)             _______% _______%    International Equities Division (152)          _______%  _______%
VIP Growth Division (253)                    _______% _______%    Mid Cap Index Division (153)                   _______%  _______%
FRANKLIN TEMPLETON VARIABLE INSURANCE                             Money Market I Division (149)                  _______%  _______%
 PRODUCTS TRUST                                                   Nasdaq-100 Index Division (167)                _______%  _______%
Franklin U.S. Government Division (191)      _______% _______%    Science & Technology Division (168)            _______%  _______%
Mutual Shares Securities Division (192)      _______% _______%    Small Cap Index Division (169)                 _______%  _______%
Templeton International Securities                                Stock Index Division (154)                     _______%  _______%
 Division (193)                              _______% _______%    VANGUARD VARIABLE INSURANCE FUND
JANUS ASPEN SERIES                                                High Yield Bond Division (188)                 _______%  _______%
Aggressive Growth Division (258)             _______% _______%    REIT Index Division (189)                      _______%  _______%
International Growth Division (256)          _______% _______%    VAN KAMPEN LIFE INVESTMENT TRUST
Worldwide Growth Division (257)              _______% _______%    Strategic Stock Division (158)                 _______%  _______%
J.P. MORGAN SERIES TRUST II                                       OTHER: ________________________________        _______%  _______%
J.P. Morgan Small Company Division (179)     _______% _______%                                                    100%       100%
MFS VARIABLE INSURANCE TRUST
MFS Capital Opportunities Division (181)     _______% _______%
MFS Emerging Growth Division (157)           _______% _______%
MFS New Discovery Division (182)             _______% _______%
MFS Research Division (180)                  _______% _______%
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                                                  PART 3.  DOLLAR COST AVERAGING
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DOLLAR COST AVERAGING: ($5,000 MINIMUM BEGINNING ACCUMULATION VALUE) An amount can be systematically transferred from the Money
Market I Division (149) and transferred to one or more of the investment options below. The USL Declared Fixed Interest Account is
not available for Dollar Cost Averaging. Please refer to the prospectus for more information on the Dollar Cost Averaging option.

DAY OF THE MONTH FOR TRANSFERS:_________________________________________________ (Choose a day of the month between 1-28.)
FREQUENCY OF TRANSFERS:         [ ] Monthly    [ ] Quarterly    [ ] Semiannually    [ ] Annually
TRANSFER $____________________   ($100 MINIMUM, WHOLE DOLLARS ONLY) from the Money Market I Division to the following division(s):

(150) AIM V.I. International Equity Division     $____________      (180) MFS Research Division                      $____________
(151) AIM V.I. Value Division                    $____________      (184) Mid-Cap Growth Division                    $____________
(166) VP Value Division                          $____________      (186) PIMCO Real Return Bond Division            $____________
(250) Ayco Growth Division                       $____________      (185) PIMCO Short-Term Bond Division             $____________
(190) Small Company Growth Division              $____________      (187) PIMCO Total Return Bond Division           $____________
(251) MidCap Stock Division                      $____________      (161) Putnam VT Diversified Income Division      $____________
(156) Quality Bond Division                      $____________      (162) Putnam VT Growth and Income Division       $____________
(155) Small Cap Division                         $____________      (163) Putnam VT Int'l Growth and Income Division $____________
(255) VIP Asset Manager Division                 $____________      (164) Equity Division                            $____________
(254) VIP Contrafund Division                    $____________      (165) Growth Opportunities Division              $____________
(252) VIP Equity-Income Division                 $____________      (159) Equity Growth Division                     $____________
(253) VIP Growth Division                        $____________      (160) High Yield Division                        $____________
(191) Franklin U.S. Government Division          $____________      (152) International Equities Division            $____________
(192) Mutual Shares Securities Division          $____________      (153) Mid Cap Index Division                     $____________
(193) Templeton International Securities         $____________      (167) Nasdaq-100 Index Division                  $____________
      Division                                                      (168) Science & Technology Division              $____________
(258) Aggressive Growth Division                 $____________      (169) Small Cap Index Division                   $____________
(256) International Growth Division              $____________      (154) Stock Index Division                       $____________
(257) Worldwide Growth Division                  $____________      (188) High Yield Bond Division                   $____________
(179) J.P. Morgan Small Company Division         $____________      (189) REIT Index Division                        $____________
(181) MFS Capital Opportunities Division         $____________      (158) Strategic Stock Division                   $____________
(157) MFS Emerging Growth Division               $____________       OTHER: _______________________________          $____________
(182) MFS New Discovery Division                 $____________

USL 8992-97                                                 PAGE 1 OF 2
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                                             THE UNITED STATES LIFE INSURANCE COMPANY
                                                  In the City of New York("USL")
                                                Administrative Center: Houston, TX

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                                                  PART 4.  AUTOMATIC REBALANCING
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AUTOMATIC REBALANCING: ($5,000 MINIMUM BEGINNING ACCUMULATION VALUE) Variable division assets will be automatically rebalanced based
on the premium percentages designated in Part 2. If the USL Declared Fixed Interest Account has been designated for premium
allocation in Part 2, the rebalancing will be based on the proportion allocated to the variable divisions. Please refer to the
prospectus for more information on the Automatic Rebalancing option.

[ ]  CHECK HERE FOR AUTOMATIC REBALANCING.

FREQUENCY:  [ ] Quarterly  [ ] Semiannually  [ ] Annually

NOTE: Automatic Rebalancing is not available if the Dollar Cost Averaging option has been chosen.

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                                      PART 5.  SUITABILITY (ALL QUESTIONS MUST BE ANSWERED.)
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                                                                                                                    YES       NO
1.  Have you, the Proposed Insured or Owner (if different), received the variable universal life insurance
    policy prospectus and the prospectuses describing the investment options?                                       [ ]      [ ]

    (If "yes," please furnish the Prospectus dates.)
        Variable Universal Life Insurance Policy Prospectus:    ______________

        Supplements (if any):                                   ______________

2.  Do you understand that under the Policy applied for:

     a.  THE AMOUNT OR DURATION OF THE DEATH BENEFIT MAY INCREASE OR DECREASE, DEPENDING ON THE
         INVESTMENT EXPERIENCE OF THE SEPARATE ACCOUNT?                                                             [ ]      [ ]

     b.  THE POLICY VALUES MAY INCREASE OR DECREASE, DEPENDING ON THE INVESTMENT EXPERIENCE OF THE SEPARATE
         ACCOUNT, THE USL DECLARED FIXED INTEREST ACCOUNT ACCUMULATION, AND CERTAIN EXPENSE DEDUCTIONS?             [ ]      [ ]

     c.  THE POLICY IS DESIGNED TO PROVIDE LIFE INSURANCE COVERAGE AND TO ALLOW FOR THE ACCUMULATION OF
         VALUES IN THE SEPARATE ACCOUNT?                                                                            [ ]      [ ]

3.  Do you believe the Policy you selected meets your insurance and investment objectives and your
    anticipated financial needs?
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Signed at:___________________________________________________________________________       Date:________________________________
               CITY                                                         STATE

X_______________________________________________________________        X___________________________________________________________
  SIGNATURE OF PRIMARY PROPOSED INSURED                                   SIGNATURE OF REGISTERED REPRESENTATIVE

X_______________________________________________________________         ___________________________________________________________
  SIGNATURE OF OWNER (if different from Proposed Insured)                    PRINT NAME OF BROKER/DEALER

X_______________________________________________________________
  SIGNATURE OF JOINT OWNER (if applicable)

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USL 8992-97                                                 PAGE 2 OF 2
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                                                                 EXHIBIT (10)(c)

            SERVICE REQUEST

                   PLATINUM
---------------------------
                INVESTOR/SM/
---------------------------
     THE UNITED STATES LIFE

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PLATINUM INVESTOR--FIXED OPTION                                 Neuberger Berman Advisers Management Trust
                                                                ------------------------------------------
 . Division 148 - USL Declared Fixed Interest Account
                                                                . Division 184 - Mid-Cap Growth
PLATINUM INVESTOR--VARIABLE DIVISIONS
                                                                PIMCO Variable Insurance Trust
AIM Variable Insurance Funds                                    ------------------------------
----------------------------                                    . Division 186 - PIMCO Real Return Bond

 . Division 150 - AIM V.I. International Equity                  . Division 185 - PIMCO Short-Term Bond

 . Division 151 - AIM V.I. Value                                 . Division 187 - PIMCO Total Return Bond

American Century Variable Portfolios. Inc.                      Putnam Variable Trust
------------------------------------------                      ---------------------

 . Division 166 - VP Value                                       . Division 161 - Putnam VT Diversified Income

Ayco Series Trust                                               . Division 162 - Putnam VT Growth and Income
-----------------
                                                                . Division 163 - Putnam VT Int'l Growth and Income
 . Division 250 - Ayco Growth
                                                                SAFECO Resource Series Trust
Credit Suisse Warburg Pincus Trust                              ----------------------------
----------------------------------
                                                                . Division 164 - Equity
 . Division 190 - Small Company Growth
                                                                . Division 165 - Growth Opportunities
Dreyfus Investment Portfolios
-----------------------------                                   The Universal Institutional Funds, Inc.
                                                                ---------------------------------------
 . Division 251 - MidCap Stock
                                                                . Division 159 - Equity Growth
Dreyfus Variable Investment Fund
--------------------------------                                . Division 160 - High Yield

 . Division 156 - Quality Bond                                   VALIC Company I
                                                                ---------------
 . Division 155 - Small Cap
                                                                . Division 152 - International Equities
Fidelity Variable Insurance Products Fund
-----------------------------------------                       . Division 153 - Mid Cap Index

 . Division 255 - VIP Asset Manager                              . Division 149 - Money Market I

 . Division 254 - VIP Contrafund                                 . Division 167 - Nasdaq-100 Index

 . Division 252 - VIP Equity-Income                              . Division 168 - Science & Technology

 . Division 253 - VIP Growth                                     . Division 169 - Small Cap Index

Franklin Templeton Variable Insurance Products Trust            . Division 154 - Stock Index
----------------------------------------------------
                                                                Vanguard Variable Insurance Fund
 . Division 191 - Franklin U.S. Government                       -------------------------------

 . Division 192 - Mutual Shares Securities                       . Division 188 - High Yield Bond

 . Division 193 - Templeton International Securities             . Division 189 - REIT Index

Janus Aspen Series                                              Van Kampen Life Investment Trust
------------------                                              --------------------------------

 . Division 258 - Aggressive Growth                              . Division 158 - Strategic Stock

 . Division 256 - International Growth

 . Division 257 - Worldwide Growth

J.P. Morgan Series Trust II
---------------------------

 . Division 179 - J.P. Morgan Small Company

MFS Variable Insurance Trust
----------------------------

 . Division 181 - MFS Capital Opportunities

 . Division 157 - MFS Emerging Growth

 . Division 182 - MFS New Discovery

 . Division 180 - MFS Research

USL 8993 REV 1101
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 Complete and return this request to:             THE UNITED STATES Life Insurance Company
        Administrative Center                          In The City of New York ("USL")
 PO Box 4880 Houston, TX 77210-4880                  Administrative Center: Houston, TX
           (800) 251-3720
Hearing Impaired (TDD): (888) 436-5258
         Fax: (877) 445-3098                  VARIABLE UNIVERSAL LIFE INSURANCE SERVICE REQUEST

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  [_]  POLICY                  1. | POLICY #:_________________________________ INSURED:_____________________________________________
       IDENTIFICATION             | ADDRESS:________________________________________________________________ New Address (yes) (no)
                                  | Primary Owner (if other than insured):__________________________________
    COMPLETE THIS SECTION FOR     | Address:________________________________________________________________ New Address (yes) (no)
        ALL REQUESTS.             | Primary Owner's S.S. No. or Tax I.D. No.______________ Phone Number:(   )_____-________________
                                  | Joint Owner (if applicable):___________________________________________________________________
                                  | Address:________________________________________________________________ New Address (yes) (no)
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  [_]  NAME                    2. | Change Name Of: (Circle One)     Insured    Owner   Payor   Beneficiary
       CHANGE                     |
Complete this section if the name | Change Name From: (First, Middle, Last)               Change Name To: (First, Middle, Last)
  of the Insured, Owner, Payor    |
   or Beneficiary has changed.    | __________________________________________________    __________________________________________
(Please note, this does not change|
  the Insured, Owner, Payor or    |
     Beneficiary designation).    | Reason for Change: (Circle One) Marriage Divorce Correction Other (Attach copy of legal proof)
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  [_]  CHANGE IN               3. | INVESTMENT DIVISION                 PREM % DED % INVESTMENT DIVISION                PREM % DED %
       ALLOCATION                 | (148) USL DECLARED FIXED INTEREST                NEUBERGER BERMAN ADVISERS MANAGEMENT TRUST
       PERCENTAGES                |      ACCOUNT                        _____ _____  (184) Mid-Cap Growth               _____ _____
  Use this section to indicate    | AIM VARIABLE INSURANCE FUNDS
     how premiums or monthly      | (150) AIM V.I. International Equity _____ _____  PIMCO VARIABLE INSURANCE TRUST
 deductions are to be allocated.  | (151) AIM V.I. Value                _____ _____  (186) PIMCO Real Return Bond       _____ _____
 Total allocation in each column  |                                                  (185) PIMCO Short-Term Bond        _____ _____
     must equal 100%; whole       | AMERICAN CENTURY VARIABLE PORTFOLIOS, INC.       (187) PIMCO Total Return Bond      _____ _____
         numbers only.            | (166) VP Value                      _____ _____
                                  |                                                  PUTNAM VARIABLE TRUST
                                  | AYCO SERIES TRUST                                (161) Putnam VT Diversified Income _____ _____
                                  | (250) Ayco Growth                   _____ _____  (162) Putnam VT Growth and Income  _____ _____
                                  |                                                  (163) Putnam VT Int'l Growth and
                                  | CREDIT SUISSE WARBURG PINCUS TRUST                       Income                     _____ _____
                                  | (190) Small Company Growth          _____ _____
                                  |                                                  SAFECO RESOURCE SERIES TRUST
                                  | DREYFUS INVESTMENT PORTFOLIOS                    (164) Equity                       _____ _____
                                  | (251) MidCap Stock                  _____ _____  (165) Growth Opportunities         _____ _____
                                  |
                                  | DREYFUS VARIABLE INVESTMENT FUND                 THE UNIVERSAL INSTITUTIONAL FUNDS, INC.
                                  | (156) Quality Bond                  _____ _____  (159) Equity Growth                _____ _____
                                  | (155) Small Cap                     _____ _____  (160) High Yield                   _____ _____
                                  |
                                  | FIDELITY VARIABLE INSURANCE PRODUCTS FUND        VALIC COMPANY I
                                  | (255) VIP Asset Manager             _____ _____  (152) International Equities       _____ _____
                                  | (254) VIP Contrafund                _____ _____  (153) Mid Cap Index                _____ _____
                                  | (252) VIP Equity-Income             _____ _____  (149) Money Market I               _____ _____
                                  | (253) VIP Growth                    _____ _____  (167) Nasdaq-100 Index             _____ _____
                                  |                                                  (168) Science & Technology         _____ _____
                                  | FRANKLIN TEMPLETON VARIABLE INSURANCE            (169) Small Cap Index              _____ _____
                                  |  PRODUCTS TRUST                                  (154) Stock Index                  _____ _____
                                  | (191) Franklin U.S. Government      _____ _____
                                  | (192) Mutual Shares Securities      _____ _____  VANGUARD VARIABLE INSURANCE FUND
                                  | (193) Templeton International       _____ _____  (188) High Yield Bond              _____ _____
                                  |       Securities                                 (189) REIT Index                   _____ _____
                                  |
                                  | JANUS ASPEN SERIES                               VAN KAMPEN LIFE INVESTMENT TRUST
                                  | (258) Aggressive Growth             _____ _____  (158) Strategic Stock              _____ _____
                                  | (256) International Growth          _____ _____
                                  | (257) Worldwide Growth              _____ _____  OTHER:_______________________      _____ _____
                                  |
                                  | J.P MORGAN SERIES TRUST II                                                          100%   100%
                                  | (179) J.P Morgan Small Company      _____ _____
                                  |
                                  | MFS VARIABLE INSURANCE TRUST
                                  | (181) MFS Capital Opportunities     _____ _____
                                  | (157) MFS Emerging Growth           _____ _____
                                  | (182) MFS New Discovery             _____ _____
                                  | (180) MFS Research                  _____ _____
                                  |
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USL 8993 REV 1101                                              PAGE 2 OF 5
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  [_]  MODE OF                 4. | Indicate frequency and premium amount desired: $______ Annual $_____ Semi-Annual $____ Quarterly
       PREMIUM                    |                                                $_____ Monthly (Bank Draft Only)
       PAYMENT/BILLING            |
       METHOD CHANGE              | Indicate billing method desired: _____Direct Bill  _____Pre-Authorized Bank Draft (attach a
  Use this section to change the  |                                                         Bank Draft Authorization Form and
 billing frequency and/or method  |                                                         "Void" Check)
  of premium payment.  Note,      |
however, that USL will not bill   | Start Date: ________/ _______/ _________
   you on a direct monthly basis. |
 Refer to your policy and its     |
 related prospectus for further   |
 information concerning minimum   |
  premiums and billing options.   |
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  [_]  LOST POLICY             5. | I/we hereby certify that the policy of insurance for the listed policy has been
       CERTIFICATE                |  ______LOST ______DESTROYED ______OTHER.
Complete this section if applying |
for a Certificate of Insurance or | Unless I/we have directed cancellation of the policy, I/we request that a:
 duplicate policy to replace a    |
 lost or misplaced policy. If a   |             _______Certificate of Insurance at no charge
 full duplicate policy is being   |
requested, a check or money order |             _______Full duplicate policy at a charge of $25
 for $25 payable to USL must be   |
  submitted with this request.    | be issued to me/us. If the original policy is located, I/we will return the Certificate
                                  | or duplicate policy to USL for cancellation.
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  [_]  DOLLAR COST             6. | Designate the day of the month for transfers: _______(choose a day from 1-28)
       AVERAGING                  | Frequency of transfers (check one): _____Monthly _____Quarterly _____Semi-Annually _____Annually
     ($5,000 minimum initial      | I want: $________________ ($100 minimum, whole dollars only) taken from the Money Market I
accumulation value) An amount may | Division (149) and transferred to the following Divisions:
be deducted periodically from the |
Money Market I Division and placed| AIM VARIABLE INSURANCE FUNDS                    NEUBERGER BERMAN ADVISERS MANAGEMENT TRUST
  in one or more of the Divisions | (150) AIM V.I. International Equity  $________  (184) Mid-Cap Growth                   $________
 listed. The USL Declared Fixed   | (151) AIM V.I. Value                 $________
Interest Account is not available |                                                 PIMCO VARIABLE INSURANCE TRUST
for Dollar Cost Averaging. Please | AMERICAN CENTURY VARIABLE PORTFOLIOS, INC.      (186) PIMCO Real Return Bond           $________
refer to the prospectus for more  | (166) VP Value                       $________  (185) PIMCO Short-Term Bond            $________
 information on the Dollar Cost   |                                                 (187) PIMCO Total Return Bond          $________
Averaging Option.                 | AYCO SERIES TRUST
                                  | (250) Ayco Growth                    $________  PUTNAM VARIABLE TRUST
                                  |                                                 (161) Putnam VT Diversified Income     $________
                                  | CREDIT SUISSE WARBURG PINCUS TRUST              (162) Putnam VT Growth and Income      $________
                                  | (190) Small Company Growth           $________  (163) Putnam VT Int'l Growth and
                                  |                                                       Income                           $________
                                  | DREYFUS INVESTMENT PORTFOLIOS
                                  | (251) MidCap Stock                   $________  SAFECO RESOURCE SERIES TRUST
                                  |                                                 (164) Equity                           $________
                                  | DREYFUS VARIABLE INVESTMENT FUND                (165) Growth Opportunities             $________
                                  | (156) Quality Bond                   $________
                                  | (155) Small Cap                      $________  THE UNIVERSAL INSTITUTIONAL FUNDS, INC.
                                  |                                                 (159) Equity Growth                    $________
                                  | FIDELITY VARIABLE INSURANCE PRODUCTS FUND       (160) High Yield                       $________
                                  | (255) VIP Asset Manager              $________
                                  | (254) VIP Contrafund                 $________  VALIC COMPANY I
                                  | (252) VIP Equity-Income              $________  (152) International Equities           $________
                                  | (253) VIP Growth                     $________  (153) Mid Cap Index                    $________
                                  |                                                 (167) Nasdaq-100 Index                 $________
                                  | FRANKLIN TEMPLETON VARIABLE INSURANCE           (168) Science & Technology             $________
                                  |  PRODUCTS TRUST                                 (169) Small Cap Index                  $________
                                  | (191) Franklin U.S. Government       $________  (154) Stock Index                      $________
                                  | (192) Mutual Shares Securities       $________
                                  | (193) Templeton International                    VANGUARD VARIABLE INSURANCE FUND
                                  |       Securities                     $________   (188) High Yield Bond                 $________
                                  |                                                  (189) REIT Index                      $________
                                  | JANUS ASPEN SERIES
                                  | (258) Aggressive Growth              $________   VAN KAMPEN LIFE INVESTMENT TRUST
                                  | (256) International Growth           $________   (158) Strategic Stock                 $________
                                  | (257) Worldwide Growth               $________
                                  |                                                  OTHER: ___________________________    $________
                                  | J.P. MORGAN SERIES TRUST II
                                  | (179) J.P. Morgan Small Company      $________
                                  |
                                  | MFS VARIABLE INSURANCE TRUST
                                  | (181) MFS Capital Opportunities      $________
                                  | (157) MFS Emerging Growth            $________
                                  | (182) MFS New Discovery              $________
                                  | (180) MFS Research                   $________
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USL 8993 REV 1101                                              PAGE 3 OF 5
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 [_]  CORRECT AGE              7. | Name of the Insured for whom this correction is submitted:______________________________________
 Use this section to correct the  |
 age of any person covered under  |
this policy. Proof of the correct | Correct DOB: _________/____________ /_____________
date of birth must accompany this |
            request.              |
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 [_]  TRANSFER OF              8. |                                     (DIVISION NAME OR NUMBER)         (DIVISION NAME OR NUMBER)
      ACCUMULATED                 |
      VALUES                      | Transfer $_______ or _______% from ____________________________ to _____________________________
  Use this section if you want to |
   move money between divisions.  | Transfer $_______ or _______% from ____________________________ to _____________________________
    Withdrawals from the USL      |
    Declared Fixed Interest       | Transfer $_______ or _______% from ____________________________ to _____________________________
    Account are limited to        |
   60 days after the policy       | Transfer $_______ or _______% from ____________________________ to _____________________________
 anniversary and to no more than  |
  25% of the total unloaned value | Transfer $_______ or _______% from ____________________________ to _____________________________
      of the USL Declared         |
  Fixed Interest Account on the   | Transfer $_______ or _______% from ____________________________ to _____________________________
policy anniversary. If a transfer |
causes the balance in any division| Transfer $_______ or _______% from ____________________________ to _____________________________
 to drop below $500, USL reserves |
    the right to transfer the     | Transfer $_______ or _______% from ____________________________ to _____________________________
remaining balance. Amounts to be  |
transferred should be indicated   | Transfer $_______ or _______% from ____________________________ to _____________________________
in dollar or percentage amounts,  |
maintainng consistency throughout.| Transfer $_______ or _______% from ____________________________ to _____________________________
                                  |
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  [_]  AUTOMATIC               9. |
       REBALANCING                | Indicate frequency: ________Quarterly ________Semi-Annually ________Annually
   ($5,000 minimum accumulation   |
 value) Use this section to apply |              (DIVISION NAME OR NUMBER)                        (DIVISION NAME OR NUMBER)
      for or make changes to      |
   Automatic Rebalancing of the   | _______% : ___________________________________     _______%  : ________________________________
 variable divisions. Please refer | _______% : ___________________________________     _______%  : ________________________________
    to the prospectus for more    | _______% : ___________________________________     _______%  : ________________________________
   information on the Automatic   | _______% : ___________________________________     _______%  : ________________________________
       Rebalancing Option.        | _______% : ___________________________________     _______%  : ________________________________
   This option is not available   | _______% : ___________________________________     _______%  : ________________________________
 while the Dollar Cost Averaging  | _______% : ___________________________________     _______%  : ________________________________
        Option is in use.         | _______% : ___________________________________     _______%  : ________________________________
                                  | _______% : ___________________________________     _______%  : ________________________________
                                  | _______% : ___________________________________     _______%  : ________________________________
                                  | _______% : ___________________________________     _______%  : ________________________________
                                  | _______% : ___________________________________     _______%  : ________________________________
                                  |
                                  |
                                  | ________  INITIAL HERE TO REVOKE AUTOMATIC REBALANCING ELECTION.
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USL 8993 REV 1101                                                   PAGE 4 OF 5
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 [_]  REQUEST FOR             10. |
      PARTIAL                     | ______I request a partial surrender of $_____ or _____% of the net cash surrender value.
      SURRENDER/                  | ______I request a loan in the amount of $_____.
      POLICY LOAN                 | ______I request the maximum loan amount available from my policy.
 Use this section to apply for a  |
 partial surrender from or policy |
 loan against policy values. For  | Unless you direct otherwise below, proceeds are allocated according to the deduction allocation
 detailed information concerning  | percentages in effect, if available; otherwise they are taken pro-rata from the USL Declared
these two options please refer to | Fixed Interest Account and Variable Divisions in use.
   your policy and its related    |
  prospectus. If applying for a   | ________________________________________________________________________________________________
  partial surrender, be sure to   |
complete the Notice of Withholding| ________________________________________________________________________________________________
 section of this Service Request  |
  in addition to this section.    | ________________________________________________________________________________________________
                                  |
------------------------------------------------------------------------------------------------------------------------------------
 [_]  NOTICE OF               11. | The taxable portion of the distribution you receive from your variable universal life insurance
      WITHHOLDING                 | policy is subject to federal income tax withholding unless you elect not to have withholding
Complete this section if you have | apply. Withholding of state income tax may also be required by your state of residence. You may
 applied for a partial surrender  | elect not to have withholding apply by checking the appropriate box below. If you elect not to
        in Section 10.            | have withholding apply to your distribution or if you do not have enough income tax withheld,
                                  | you may be responsible for payment of estimated tax. You may incur penalties under the
                                  | estimated tax rules, if your withholding and estimated tax are not sufficient.
                                  |
                                  | Check one: ________I DO want income tax withheld from this distribution.
                                  |
                                  |            ________I DO NOT want income tax withheld from this distribution.
                                  |
                                  |
------------------------------------------------------------------------------------------------------------------------------------
 [_]  AFFIRMATION/            12. | CERTIFICATION: UNDER PENALTIES OF PERJURY, I CERTIFY: (1) THAT THE NUMBER SHOWN ON THIS FORM IS
      SIGNATURE                   | MY CORRECT TAXPAYER IDENTIFICATION NUMBER AND; (2) THAT I AM NOT SUBJECT TO BACKUP WITHHOLDING
   Complete this section for      | UNDER SECTION 3406(A)(1)(C) OF THE INTERNAL REVENUE CODE.
         ALL requests.            |
                                  | THE INTERNAL REVENUE SERVICE DOES NOT REQUIRE YOUR CONSENT TO ANY PROVISION OF THIS DOCUMENT
                                  | OTHER THAN THE CERTIFICATION REQUIRED TO AVOID BACKUP WITHHOLDING.
                                  |
                                  | Dated at_______________this___________day of______________________________________,__________
                                  |         (City, State)
                                  | X______________________________________________   X__________________________________________
                                  |  SIGNATURE OF OWNER                                SIGNATURE OF WITNESS
                                  |
                                  | X______________________________________________   X__________________________________________
                                  |  SIGNATURE OF JOINT OWNER                          SIGNATURE OF WITNESS
                                  |
                                  | X______________________________________________   X__________________________________________
                                  |  SIGNATURE OF ASSIGNEE                             SIGNATURE OF WITNESS
                                  |
------------------------------------------------------------------------------------------------------------------------------------
USL 8993 REV 1101                                              PAGE 5 OF 5
</TABLE>

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