Document:

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                                                                 EXHIBIT (10)(d)

            SERVICE REQUEST

                   PLATINUM
---------------------------
   INVESTOR(SM) SURVIVOR II
---------------------------
      AMERICAN GENERAL LIFE

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PLATINUM INVESTOR SURVIVOR II--FIXED OPTION                     MFS Variable Insurance Trust
                                                                ----------------------------
.. Division 18 - AGL Declared Fixed Interest Account
                                                                . Division 165 - MFS Capital Opportunities
PLATINUM INVESTOR SURVIVOR II--VARIABLE DIVISIONS
                                                                . Division 141 - MFS Emerging Growth
AIM Variable Insurance Funds
----------------------------                                    . Division 166 - MFS New Discovery

.. Division 130 - AIM V.I. International Growth                  . Division 164 - MFS Research

.. Division 131 - AIM V.I. Premier Equity                        Neuberger Berman Advisers Management Trust
                                                                ------------------------------------------
American Century Variable Portfolios, Inc.
------------------------------------------                      . Division 167 - Mid-Cap Growth

.. Division 153 - VP Value                                       PIMCO Variable Insurance Trust
                                                                ------------------------------
Ayco Series Trust
-----------------                                               . Division 169 - PIMCO Real Return Bond

.. Division 154 - Ayco Growth                                    . Division 168 - PIMCO Short-Term Bond

Credit Suisse Trust                                             . Division 170 - PIMCO Total Return Bond
-------------------
                                                                Putnam Variable Trust
.. Division 173 - Small Cap Growth                               ---------------------

Dreyfus Investment Portfolios                                   . Division 144 - Putnam VT Diversified Income
-----------------------------
                                                                . Division 145 - Putnam VT Growth and Income
.. Division 155 - MidCap Stock
                                                                . Division 146 - Putnam VT Int'l Growth and Income
Dreyfus Variable Investment Fund
--------------------------------                                SAFECO Resource Series Trust
                                                                ----------------------------
.. Division 139 - Quality Bond
                                                                . Division 147 - Equity
.. Division 140 - Small Cap
                                                                . Division 148 - Growth Opportunities
Fidelity Variable Insurance Products Fund
-----------------------------------------                       SunAmerica Series Trust
                                                                -----------------------
.. Division 159 - VIP Asset Manager
                                                                . Division 179 - Aggressive Growth
.. Division 158 - VIP Contrafund
                                                                . Division 178 - SunAmerica Blended
.. Division 156 - VIP Equity-Income
                                                                The Universal Institutional Funds, Inc.
.. Division 157 - VIP Growth                                     ---------------------------------------

Franklin Templeton Variable Insurance Products Trust            . Division 142 - Equity Growth
----------------------------------------------------
                                                                . Division 143 - High Yield
.. Division 174 - Franklin U.S. Government
                                                                VALIC Company I
.. Division 175 - Mutual Shares Securities                       ----------------

.. Division 176 - Templeton Foreign Securities                   . Division 132 - International Equities

Janus Aspen Series                                              . Division 133 - Mid Cap Index
------------------
                                                                . Division 134 - Money Market I
.. Division 162 - Aggressive Growth
                                                                . Division 136 - Nasdaq-100 Index
.. Division 160 - International Growth
                                                                . Division 137 - Science & Technology
.. Division 161 - Worldwide Growth
                                                                . Division 138 - Small Cap Index
J.P. Morgan Series Trust II
---------------------------                                     . Division 135 - Stock Index

.. Division 163 - JPMorgan Small Company                         Vanguard Variable Insurance Fund
                                                                --------------------------------

                                                                . Division 171 - High Yield Bond

                                                                . Division 172 - REIT Index

                                                                Van Kampen Life Investment Trust
                                                                --------------------------------

                                                                . Division 149 - Growth & Income

AGLC 0463 Rev0302
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 COMPLETE AND RETURN THIS REQUEST TO:        AMERICAN GENERAL LIFE INSURANCE COMPANY ("AGL")                AMERICAN
  Variable Universal Life Operations            MEMBER AMERICAN INTERNATIONAL GROUP, INC.                     | GENERAL
 PO Box 4880 Houston, TX 77210-4880                         Houston, Texas                                    | FINANCIAL GROUP
  (888) 325-9315 or (713) 831-3443
        Fax: (877) 445-3098
Hearing Impaired/TDD: (888) 436-5258           VARIABLE UNIVERSAL LIFE INSURANCE SERVICE REQUEST

------------------------------------------------------------------------------------------------------------------------------------
  [_]  POLICY                  1. | POLICY #:_________________________________ CONTINGENT INSURED:__________________________________
       IDENTIFICATION             |                                            CONTINGENT INSURED: _________________________________
    COMPLETE THIS SECTION FOR     | ADDRESS:________________________________________________________________ New Address (yes) (no)
        ALL REQUESTS.             | Primary Owner (if other than an insured):_______________________________
                                  | Address:________________________________________________________________ New Address (yes) (no)
                                  | 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)     Contingent Insured    Owner   Payor   Beneficiary
       CHANGE                     |
Complete this section if the name | Change Name From: (First, Middle, Last)               Change Name To: (First, Middle, Last)
of one of the Contingent Insureds,| __________________________________________________    __________________________________________
 Owner, Payor or Beneficiary has  |
 changed. (Please note, this does | Reason for Change: (Circle One) Marriage Divorce Correction Other (Attach copy of legal proof)
     not change the Contingent    |
     Insureds, Owner, Payor or    |
     Beneficiary designation)     |
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  [_]  CHANGE IN               3. | INVESTMENT DIVISION               PREM % DED %   INVESTMENT DIVISION              PREM %  DED %
       ALLOCATION                 | (18) AGL Declared Fixed Interest                 Neuberger Berman Advisers Management Trust
       PERCENTAGES                |      Account                      ______ ______  (167) Mid-Cap Growth             ______  ______
  Use this section to indicate    |
     how premiums or monthly      | AIM Variable Insurance Funds                     PIMCO Variable Insurance Trust
 deductions are to be allocated.  | (130) AIM V.I. International                     (169) PIMCO Real Return          ______  ______
 Total allocation in each column  |       Growth                      ______ ______  (168) PIMCO Short-Term           ______  ______
     must equal 100%; whole       | (131) AIM V.I. Premier  Equity    ______ ______  (170) PIMCO Total Return         ______  ______
         numbers only.            |
                                  | American Century Variable Portfolios, Inc.       Putnam Variable Trust
                                  | (153) VP Value                    ______ ______  (144) Putnam VT Diversified
                                  |                                                        Income                     ______  ______
                                  | Ayco Series Trust                                (145) Putnam VT Growth and
                                  | (154) Ayco Growth                 ______ ______        Income                     ______  ______
                                  |                                                  (146) Putnam VT Int'l Growth
                                  | Credit Suisse Trust                                    and Income                 ______  ______
                                  | (173) Small Cap Growth            ______ ______
                                  |                                                  SAFECO Resource Series Trust
                                  | Dreyfus Investment Portfolios                    (147) Equity                     ______  ______
                                  | (155) MidCap Stock                ______ ______  (148) Growth Opportunities       ______  ______
                                  |
                                  | Dreyfus Variable Investment Fund                  SunAmerica Series Trust
                                  | (139) Quality Bond                ______ ______   (179) Aggressive Growth         ______  ______
                                  | (140) Small Cap                   ______ ______   (178) SunAmerica Balanced       ______  ______
                                  |
                                  | Fidelity Variable Insurance Products Fund         The Universal Institutional Funds, Inc.
                                  | (159) VIP Asset Manager           ______ ______   (142) Equity Growth             ______  ______
                                  | (158) VIP Contrafund              ______ ______   (143) High Yield                ______  ______
                                  | (156) VIP Equity-Income           ______ ______
                                  | (157) VIP Growth                  ______ ______    VALIC Company I
                                  |                                                    (132) International Equities   ______  ______
                                  | Franklin Templeton Variable Insurance Products     (133) Mid Cap Index            ______  ______
                                  | Trust                                              (134) Money Market I           ______  ______
                                  | (174) Franklin U.S. Government    ______ ______    (136) Nasdaq-100 Index         ______  ______
                                  | (175) Mutual Shares Securities    ______ ______    (137) Science & Technology     ______  ______
                                  | (176) Templeton Foreign                            (138) Small Cap Index          ______  ______
                                  |       Securities                  ______ ______    (135) Stock Index              ______  ______
                                  |
                                  | Janus Aspen Series                                 Vanguard Variable Insurance Fund
                                  | (162) Aggressive Growth           ______ ______    (171) High Yield Bond          ______  ______
                                  | (160) International Growth        ______ ______    (172) REIT Index               ______  ______
                                  | (161) Worldwide Growth            ______ ______
                                  |                                                    Van Kampen Life Investment Trust
                                  | J.P. Morgan Series Trust II                        (149) Growth & Income          ______  ______
                                  | (163) JPMorgan Small Company      ______ ______
                                  |                                                    OTHER:                         ______  ______
                                  | MFS Variable Insurance Trust                                                       100%    100%
                                  | (165) MFS Capital Opportunities   ______ ______
                                  | (141) MFS Emerging Growth         ______ ______
                                  | (166) MFS New Discovery           ______ ______
                                  | (164) MFS Research                ______ ______
                                  |
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AGLC 0463 Rev0302                                              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 AGL 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 AGL 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 AGL 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 and transferred to the following Divisions:
be deducted periodically from the |
  Money Market I Division and     | (18) AGL Declared Fixed Interest                Neuberger Berman Advisers Management Trust
  placed in one or more of the    | --------------------------------                ------------------------------------------
        Divisions listed.         | Account                               $_______  (167) Mid-Cap Growth                    $_______
     The AGL Declared Fixed       | -------
Interest Account is not available |                                                 PIMCO Variable Insurance Trust
    for Dollar Cost Averaging.    | AIM Variable Insurance Funds                    ------------------------------
 Please refer to the prospectus   | -----------------------------                   (169) PIMCO Real Return                 $_______
   for more information on the    | (130) AIM V.I. International Growth   $_______  (168) PIMCO Short-Term                  $_______
  Dollar Cost Averaging Option.   | (131) AIM V.I. Premier Equity         $_______  (170) PIMCO Total Return                $_______
    Note: Automatic Rebalancing   |
  is not available if the Dollar  | American Century Variable Portfolios            Putnam Variable Trust
    Cost Averaging Option is      | ------------------------------------            ---------------------
           chosen.                | (153) VP Value                        $_______  (144) Putnam VT Diversified Income      $_______
                                  |                                                 (145) Putnam VT Growth and Income       $_______
                                  | Ayco Series Trust                               (146) Putnam VT Int'l Growth and Income $_______
                                  | -----------------
                                  | (154) Ayco Growth                     $_______  SAFECO Resource Series Trust
                                  |                                                 ----------------------------
                                  | Credit Suisse Trust                             (147) Equity                            $_______
                                  | -------------------                             (148) Growth Opportunities              $_______
                                  | (173) Small Cap Growth                $_______
                                  |                                                 SunAmerica Series Trust
                                  | Dreyfus Investment Portfolios                   -----------------------
                                  | -----------------------------                   (179) Aggressive Growth                 $_______
                                  | (155) MidCap Stock                    $_______  (178) SunAmerica Balanced               $_______
                                  |
                                  | Dreyfus Variable Investment Fund                The Universal Institutional Funds, Inc.
                                  | --------------------------------                ---------------------------------------
                                  | (139) Quality Bond                    $_______  (142) Equity Growth                     $_______
                                  | (140) Small Cap                       $_______  (143) High Yield                        $_______
                                  |
                                  | Fidelity Variable Insurance Products Fund       VALIC Company I
                                  | -----------------------------------------       ---------------
                                  | (159) VIP Asset Manager               $_______  (132) International Equities            $_______
                                  | (158) VIP Contrafund                  $_______  (133) Mid Cap Index                     $_______
                                  | (156) VIP Equity-Income               $_______  (136) Nasdaq-100 Index                  $_______
                                  | (157) VIP Growth                      $_______  (137) Science & Technology              $_______
                                  |                                                 (138) Small Cap Index                   $_______
                                  | Franklin Templeton Variable Insurance           (135) Stock Index                       $_______
                                  | -------------------------------------
                                  | Products Trust                                  Vanguard Variable Insurance Fund
                                  | --------------                                  --------------------------------
                                  | (174) Franklin U.S. Government        $_______  (171) High Yield Bond                   $_______
                                  | (175) Mutual Shares Securities        $_______  (172) REIT Index                        $_______
                                  | (176) Templeton Foreign Securities    $_______
                                  |                                                 Van Kampen Life Investment Trust
                                  | Janus Aspen Series                              --------------------------------
                                  | ------------------                              (149) Growth & Income                   $_______
                                  | (162) Aggressive Growth               $_______
                                  | (160) International Growth            $_______  Other:_____________________________     $_______
                                  | (161) Worldwide Growth                $_______  ------
                                  |
                                  | J.P. Morgan Series Trust II
                                  | ---------------------------
                                  | (163) JPMorgan Small Company          $_______
                                  |
                                  | MFS Variable Insurance Trust
                                  | ----------------------------
                                  | (165) MFS Capital Opportunities       $_______
                                  | (141) MFS Emerging Growth             $_______
                                  | (166) MFS New Discovery               $_______
                                  | (164) MFS Research                    $_______
                                  | _______ INITIAL HERE TO REVOKE DOLLAR COST AVERAGING ELECTION.
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AGLC 0463 Rev0302                                              PAGE 3 OF 5
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  [_]  AUTOMATIC               7. |
       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.        | _________%:___________________________________      ________%:________________________________
 Note: Dollar Cost Averaging is   |
 not available if the Automatic   | _________%:___________________________________      ________%:________________________________
  Rebalancing Option is chosen.   |
                                  | _________%:___________________________________      ________%:________________________________
                                  |
                                  | _________%:___________________________________      ________%:________________________________
                                  |
                                  | _________%:___________________________________      ________%:________________________________
                                  |
                                  | _________%:___________________________________      ________%:________________________________
                                  |
                                  | _________%:___________________________________      ________%:________________________________
                                  |
                                  | _________%:___________________________________      ________%:________________________________
                                  |
                                  | ______________Initial Here To Revoke Automatic Rebalancing Election.
                                  |
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  [_]  TELEPHONE               8. | I(/we if Joint Owners) hereby authorize AGL to act on telephone instructions to transfer values
       PRIVILEGE                  | among the Variable Divisions and AGL Declared Fixed Interest Account and to change allocations
       AUTHORIZATION              | for future purchase payments and monthly deductions.
Complete this section if you are  |
applying for or revoking current  | Initial the designation you prefer:
     telephone privileges.        |
                                  | _________Policy Owner(s) ONLY - If Joint Owners, either one acting independently.
                                  |
                                  | _________Policy Owner(s) OR Agent/Registered Representative who is appointed to represent AGL
                                  |          and the firm authorized to service my policy.
                                  |
                                  | AGL and any non-owner designated by this authorization will not be responsible for any claim,
                                  | loss or expense based upon telephone transfer or allocation instructions received and acted upon
                                  | in good faith, including losses due to telephone instruction communication errors. AGL's
                                  | liability for erroneous transfers or allocations, unless clearly contrary to instructions
                                  | received, will be limited to correction of the allocations on a current basis. If an error,
                                  | objection or other claim arises due to a telephone transaction, I will notify AGL in writing
                                  | within five working days from the receipt of the confirmation of the transaction from AGL. I
                                  | understand that this authorization is subject to the terms and provisions of my variable
                                  | universal life insurance policy and its related prospectus. This authorization will remain in
                                  | effect until my written notice of its revocation is received by AGL at the address printed on
                                  | the top of this service request form.
                                  |
                                  | _______Initial Here To Revoke Telephone privilege authorization.
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 [_]  CORRECT AGE              9. |
 Use this section to correct the  | Name of Contingent Insured for whom this correction is submitted: ____________________________
 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             10. |                                     (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 ____________________________.
The minimum amount for transfers  |
is $500.00. Withdrawals from the  | Transfer $_______ or _______% from ____________________________ to ____________________________.
  AGL Declared Fixed Interest     |
Account to a Variable Division    | Transfer $_______ or _______% from ____________________________ to ____________________________.
may only be made within the 60    |
days after a contract anniversary.| Transfer $_______ or _______% from ____________________________ to ____________________________.
See transfer limitations outlined |
 in prospectus. If a transfer     | Transfer $_______ or _______% from ____________________________ to ____________________________.
      causes the balance in       |
   any division to drop below     | Transfer $_______ or _______% from ____________________________ to ____________________________.
 $500, AGL reserves the right     |
to transfer the remaining balance.| Transfer $_______ or _______% from ____________________________ to ____________________________.
 Amounts to be transferred should |
    be indicated in dollar or     | Transfer $_______ or _______% from ____________________________ to ____________________________.
  percentage amounts, maintaining |
     consistency throughout.      | Transfer $_______ or _______% from ____________________________ to ____________________________.
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AGLC 0463 Rev0302                                                   PAGE 4 OF 5
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 [_]  REQUEST FOR PARTIAL     11. | _______ I request a partial surrender of $________ or _______% of the net cash surrender value.
      SURRENDER/POLICY LOAN       |
                                  | _______ I request a loan in the amount of $__________.
 Use this section to apply for a  |
partial surrender from or policy  | _______ I request the maximum loan amount available from my policy.
loan against policy values. For   |
detailed information concerning   | Unless you direct otherwise below, proceeds are allocated according to the deduction allocation
 these two options please refer   | percentages in effect, if available; otherwise they ar taken pro-rata from the AGL Declared
 to your policy and its related   | Fixed Interest Account and Variable Divisions in use.
 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.             | _______________________________________________________________________________________________
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 [_]  NOTICE OF               12. | 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 11.            | 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.
                                  |
                                  | If no election is made, we are REQUIRED to withhold Federal Income Tax (if applicable).
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 [_]  AFFIRMATION/            10. | 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
                                  |
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AGLC 0463 Rev0302                                               PAGE 5 OF 5
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                                                                 EXHIBIT (10)(f)
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<CAPTION>

             PLATINUM INVESTOR SURVIVOR II                                                                   AMERICAN
             JOINT AND LAST SURVIVOR VARIABLE UNIVERSAL                                                         |GENERAL
             LIFE INSURANCE SUPPLEMENTAL APPLICATION                                                            |FINANCIAL GROUP

             AMERICAN GENERAL LIFE INSURANCE COMPANY,  ("AGL")
             Home Office: Houston, TX

             Member of American General Financial Group. American General Financial Group is the marketing name for American General
             Corporation and its subsidiaries.

             (This supplement must accompany the appropriate application for life insurance.)
<S>                                                                         <C>
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APPLICANT INFORMATION - SUPPLEMENT TO THE APPLICATION ON THE LIVES OF
-----------------------------------------------------------------------------------------------------------------------------------

--------------------------------------   ------------------------------------------   ---------------------------------------------
Name of Proposed Contingent Insured      Name of Other Proposed Contingent Insured    Date of application for life insurance

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INITIAL ALLOCATION PERCENTAGES
-----------------------------------------------------------------------------------------------------------------------------------
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
                                          ----------  ----------                                             ----------  ----------
AGL Declared Fixed Interest Account (18)    _____%     _____%     NEUBERGER BERMAN ADVISERS MANAGEMENT TRUST
                                                                  Mid-Cap Growth Division (167)                    _____%     ____%
AIM VARIABLE INSURANCE FUNDS
AIM V.I. International Growth Division (130)_____%     _____%     PIMCO VARIABLE INSURANCE TRUST
AIM V.I. Premier Equity Division (131)      _____%     _____%     PIMCO Real Return Division (169)                 _____%     _____%
                                                                  PIMCO Short-Term Division (168)                  _____%     _____%
AMERICAN CENTURY VARIABLE PORTFOLIOS, INC.                        PIMCO Total Return Division (170)                _____%     _____%
VP Value Division (153)                     _____%     _____%
                                                                  PUTNAM VARIABLE TRUST
AYCO SERIES TRUST                                                 Putnam VT Diversified Income Division (144)      _____%     _____%
Ayco Growth Division (154)                  _____%     _____%     Putnam VT Growth and Income Division (145)       _____%     _____%
                                                                  Putnam VT Int'l Growth and Income Division (146) _____%     _____%
CREDIT SUISSE TRUST
Small Cap Growth Division (173)             _____%     _____%     SAFECO RESOURCE SERIES TRUST
                                                                  Equity Division (147)                            _____%     _____%
DREYFUS INVESTMENT PORTFOLIOS                                     Growth Opportunities Division (148)              _____%     _____%
MidCap Stock Division (155)                 _____%     _____%
                                                                  SUNAMERICA SERIES TRUST
DREYFUS VARIABLE INVESTMENT FUND                                  SunAmerica Balanced Division (178)               _____%     _____%
Quality Bond Division (139)                 _____%     _____%     Aggressive Growth Division (179)                 _____%     _____%
Small Cap Division (140)                    _____%     _____%
                                                                  THE UNIVERSAL INSTITUTIONAL FUNDS, INC.
FIDELITY VARIABLE INSURANCE PRODUCTS FUND                         Equity Growth Division (142)                     _____%     _____%
VIP Asset Manager Division (159)            _____%     _____%     High Yield Division (143)                        _____%     _____%
VIP Contrafund Division (158)               _____%     _____%
VIP Equity-Income Division (156)            _____%     _____%     VALIC COMPANY I
VIP Growth Division (157)                   _____%     _____%     International Equities Division (132)            _____%     _____%
                                                                  Mid Cap Index Division (133)                     _____%     _____%
FRANKLIN TEMPLETON VARIABLE INSURANCE PRODUCTS TRUST              Money Market I Division (134)                    _____%     _____%
Franklin U.S. Government Division (174)     _____%     _____%     Nasdaq-100 Index Division (136)                  _____%     _____%
Mutual Shares Securities Division (175)     _____%     _____%     Science & Technology Division (137)              _____%     _____%
Templeton Foreign Securities Division (176) _____%     _____%     Small Cap Index Division (138)                   _____%     _____%
                                                                  Stock Index Division (135)                       _____%     _____%
JANUS ASPEN SERIES
Aggressive Growth Division (162)            _____%     _____%     VANGUARD VARIABLE INSURANCE FUND
International Growth Division (160)         _____%     _____%     High Yield Bond Division (171)                   _____%     _____%
Worldwide Growth Division (161)             _____%     _____%     REIT Index Division (172)                        _____%     _____%

J.P. MORGAN SERIES TRUST II                                       VAN KAMPEN LIFE INVESTMENT TRUST
JPMorgan Small Company Division (163)       _____%     _____%     Growth & Income Division (177)                   _____%     _____%

MFS VARIABLE INSURANCE TRUST                                      OTHER:_____________________________              _____%     _____%
MFS Capital Opportunities Division (165)    _____%     _____%                                                       100%       100%
MFS Emerging Growth Division (141)          _____%     _____%
MFS New Discovery Division (166)            _____%     _____%
MFS Research Division (164)                 _____%     _____%
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AGLC 0461-2001                                                                                                          Page  1 of 4
                                                                                                                                0502
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DOLLAR COST AVERAGING
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DOLLAR COST    ($5,000 MINIMUM BEGINNING ACCUMULATION VALUE) An amount can be systematically transferred from the Money Market I
AVERAGING      Division and transferred to one or more of the investment options below. The AGL 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)
               ___________________________________________             ___________________________________

AIM VARIABLE INSURANCE FUNDS                                     NEUBERGER BERMAN ADVISERS MANAGEMENT TRUST
AIM V.I. International Growth Division (130) $__________         Mid-Cap Growth Division (167)                       $__________
AIM V.I. Premier Equity Division (131)       $__________
                                                                 PIMCO VARIABLE INSURANCE TRUST
AMERICAN CENTURY VARIABLE PORTFOLIOS, INC.                       PIMCO Real Return Division (169)                    $__________
VP Value Division (153)                      $__________         PIMCO Short-Term Division (168)                     $__________
                                                                 PIMCO Total Return Division (170)                   $__________
AYCO SERIES TRUST
Ayco Growth Division (154)                   $__________         PUTNAM VARIABLE TRUST
                                                                 Putnam VT Diversified Income Division (144)         $__________
CREDIT SUISSE TRUST                                              Putnam VT Growth and Income Division (145)          $__________
Small Cap Growth Division (173)              $__________         Putnam VT Int'l Growth and Income Division (146)    $__________

DREYFUS INVESTMENT PORTFOLIOS                                    SAFECO RESOURCE SERIES TRUST
MidCap Stock Division (155)                  $__________         Equity Division (147)                               $__________
                                                                 Growth Opportunities Division (148)                 $__________
DREYFUS VARIABLE INVESTMENT FUND
Quality Bond Division (139)                  $__________         SUNAMERICA SERIES TRUST
Small Cap Division (140)                     $__________         SunAmerica Balanced Division (178)                  $__________
                                                                 Aggressive Growth Division (179)                    $__________
FIDELITY VARIABLE INSURANCE PRODUCTS FUNDS
VIP Asset Manager Division (159)             $__________         THE UNIVERSAL INSTITUTIONAL FUNDS, INC.
VIP Contrafund Division (158)                $__________         Equity Growth Division (142)                        $__________
VIP Equity-Income Division (156)             $__________         High Yield Division (143)                           $__________
VIP Growth Division (157)                    $__________
                                                                 VALIC COMPANY I
FRANKLIN TEMPLETON VARIABLE INSURANCE PRODUCTS TRUST             International Equities Division (132)               $__________
Franklin U.S. Government Division (174)      $__________         Mid Cap Index Division (133)                        $__________
Mutual Shares Securities Division (175)      $__________         Nasdaq-100 Index Division (136)                     $__________
Templeton Foreign Securities Division (176)  $__________         Science & Technology Division (137)                 $__________
                                                                 Small Cap Index Division (138)                      $__________
JANUS ASPEN SERIES                                               Stock Index Division (135)                          $__________
Aggressive Growth Division (162)             $__________
International Growth Division (160)          $__________         VANGUARD VARIABLE INSURANCE FUND
Worldwide Growth Division (161)              $__________         High Yield Bond Division (171)                      $__________
                                                                 REIT Index Division (172)                           $__________
J.P. MORGAN SERIES TRUST II
JPMorgan Small Company Division (163)        $__________         VAN KAMPEN LIFE INVESTMENT TRUST
                                                                 Growth & Income Division (177)                      $__________
MFS VARIABLE INSURANCE TRUST
MFS Capital Opportunities Division (165)     $__________         OTHER:_______________________________               $__________
MFS Emerging Growth Division (141)           $__________
MFS New Discovery Division (166)             $__________
MFS Research Division (164)                  $__________
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AUTOMATIC REBALANCING
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AUTOMATIC      ($5,000 MINIMUM BEGINNING ACCUMULATION VALUE) Variable division assets will be automatically rebalanced based on the
REBALANCING    premium percentages designated on Page 1 of this form. If the AGL Declared Fixed Interest Account has been designated
               for premium allocation, 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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MODIFIED ENDOWMENT CONTRACT
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CONTRACT       If any premium payment causes the policy to be classified as a modified endowment contract under Section 7702A of the
               Internal Revenue Code, there may be potentially adverse tax consequences. Such consequences include: (1) withdrawals
               or loans being taxed to the extent of gain; and (2) a 10% penalty tax on the taxable amount. In order to avoid
               modified endowment status, I request any excess premium that could cause such status to be refunded.
                                                                                                         [_] YES   [_] NO
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AGLC 0461-2001                                                                                                           Page 2 of 4
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DEATH BENEFIT COMPLIANCE TEST
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                           [_] Guideline Premium Test                           [_] Cash Value Accumulation Test

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SPECIFIED AMOUNT
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Base Coverage $______________________plus Supplemental Coverage $ _________________________ = Total Specified Amount $ _____________

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TELEPHONE AUTHORIZATION
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                      I (or we, if Joint Owners), hereby authorize American General Life Insurance Company ("AGL") to act on
                      telephone instructions to transfer values among the variable divisions and the AGL Declared Fixed Interest
                      Account and to change allocations for future premium payments and monthly deductions given by:

INITIAL APPROPRIATE   [    ]  Policy Owner(s)- if Joint Owners, either of us acting independently.
BOX HERE:
                      [    ]  Policy Owner(s) or the Agent/Registered Representative who is appointed to represent AGL and the firm
                              authorized to service my policy.

                      AGL and any person designated by this authorization will not be responsible for any claim, loss or expense
                      based upon telephone instructions received and acted on in good faith, including losses due to telephone
                      instruction communication errors. AGL's liability for erroneous transfers and allocations, unless clearly
                      contrary to instructions received, will be limited to correction of the allocations on a current basis. If an
                      error, objection or other claim arises due to a telephone transaction, I will notify AGL in writing within
                      five working days from receipt of confirmation of the transaction from AGL. I understand that this
                      authorization is subject to the terms and provisions of my variable universal life insurance policy and its
                      related prospectus. This authorization will remain in effect until my written notice of its revocation is
                      received by AGL at its home office.

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SUITABILITY
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ALL QUESTIONS MUST    1. Have you, the Proposed Insured or Owner(s) (if different), received the variable universal life
BE ANSWERED:             insurance policy prospectus and the prospectuses describing the investment options?         [_] yes  [_] no

                         (IF "YES," PLEASE FURNISH THE PROSPECTUS DATES.)

                             Variable Universal Life Insurance Policy Prospectus:     __________

                             Supplements (if any):                                    __________

                      2. Do you understand and acknowledge:

                         a. THAT THE POLICY APPLIED FOR IS VARIABLE, EMPLOYS THE USE OF SEGREGATED ACCOUNTS WHICH
                            MEANS THAT YOU NEED TO RECEIVE AND UNDERSTAND CURRENT PROSPECTUSES FOR THE POLICY AND
                            THE UNDERLYING ACCOUNTS?                                                                 [_] yes  [_] no

                         b. THAT ANY BENEFITS, VALUES OR PAYMENTS BASED ON PERFORMANCE OF THE SEGREGATED
                            ACCOUNTS MAY VARY: AND                                                                   [_] yes  [_] no

                            (1)  ARE NOT GUARANTEED BY THE COMPANY, ANY OTHER INSURANCE COMPANY, THE U.S.
                                 GOVERNMENT OR ANY STATE GOVERNMENT?                                                 [_] yes  [_] no

                            (2)  ARE NOT FEDERALLY INSURED BY THE FDIC, THE FEDERAL RESERVE BOARD OR ANY
                                 OTHER AGENCY, FEDERAL OR STATE?                                                     [_] yes  [_] no

                         c. THAT IN ESSENCE, ALL RISK IS BORNE BY THE OWNER EXCEPT FOR FUNDS PLACED IN
                            THE AGL DECLARED FIXED INTEREST ACCOUNT?                                                 [_] yes  [_] no

                         d. THAT THE POLICY IS DESIGNED TO PROVIDE LIFE INSURANCE COVERAGE AND TO ALLOW FOR
                            THE ACCUMULATION OF VALUES IN THE SEGREGATED ACCOUNTS?                                   [_] yes  [_] no

                         e. THE AMOUNT OR DURATION OF THE DEATH BENEFIT MAY INCREASE OR DECREASE, DEPENDING
                            ON THE INVESTMENT EXPERIENCE OF THE SEPARATE ACCOUNT?                                    [_] yes  [_] no

                         f. THE POLICY VALUES MAY INCREASE OR DECREASE, DEPENDING ON THE INVESTMENT
                            EXPERIENCE OF THE SEPARATE ACCOUNT, THE AGL DECLARED FIXED INTEREST ACCOUNT
                            ACCUMULATION, AND CERTAIN EXPENSE DEDUCTIONS?                                            [_] yes  [_] no

                      3. Do you believe the Policy you selected meets your insurance and investment
                         objectives and your anticipated financial needs?                                            [_] yes  [_] no
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AGLC 0461-2001                                                                                                           Page 3 of 4
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ACKNOWLEDGEMENTS
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             The following states require the applicants to acknowledge the information below that pertains to their specific
             State. Check the appropriate box for your application state, and sign and date the Your Signature section below.

             [_] FLORIDA
                 Any person who knowingly and with intent to injure, defraud or deceive any insurer files a statement of claim or
                 an application containing any false, incomplete or misleading information is guilty of a felony of the third
                 degree.

             [_] MAINE
                 It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the
                 purpose of defrauding the company. Penalties may include imprisonment, fines or denial of insurance benefit.

             [_] NEW MEXICO
                 Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly
                 presents false information in an application for insurance is guilty of a crime and may be subject to civil
                 fines and criminal penalties.

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YOUR SIGNATURE
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SIGNATURES   Signed at (city, state)
             -----------------------------------------------------------------------------------------------------------------------

             Print name of Broker/Dealer
             -----------------------------------------------------------------------------------------------------------------------

             X Registered Representative                                      State license #                   Date
             ---------------------------------------------------------------  -------------------------------   --------------------

             X Primary Contingent insured                                                                       Date
             ------------------------------------------------------------------------------------------------   -------------------

             X Other Proposed Contingent Insured                                                                Date
             ------------------------------------------------------------------------------------------------   -------------------

             X Owner                                                                                            Date
             ------------------------------------------------------------------------------------------------   -------------------
             (If different from Proposed Contingent Insured)

             X Additional Owner                                                                                  Date
             ------------------------------------------------------------------------------------------------   -------------------
             (If different from Other Proposed Contingent Insured)
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AGLC 0461-2001                                                                                                         Page 4 of 4
                                                                                                                                0502
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