Document:

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                                                                   EXHIBIT 10(d)

                                                              AMERICAN
                                                                |GENERAL
                                                                |FINANCIAL GROUP
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VARIABLE UNIVERSAL LIFE INSURANCE
SUPPLEMENTAL APPLICATION

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

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.)
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APPLICANT INFORMATION - SUPPLEMENT TO THE APPLICATION ON THE LIVES OF
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<S>                                            <C>                                           <C>

-----------------------------------------------------------------------     -------------------------------------------------------
Name of proposed insured                                                    Date of application for life insurance

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INITIAL ALLOCATION PERCENTAGES
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ALLOCATION STYLES     By selecting an Allocation Style below, you agree to allocate 100% of your premium as designated in the most
                      recent publication of Platinum Investor VUL Allocation Styles.

                      [_] Capital preservation   [_] Income and growth   [_] Growth and income   [_] Growth
                      [_] Aggressive growth      [_] All equity          [_] _________________   [_] __________________

                      NOTE: If an Allocation Style is selected, the deduction of monthly account charges will be allocated in the
                      same percentage as the premium allocation.
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                      THIS SECTION TO BE COMPLETED EVEN IF AN ALLOCATION STYLE HAS BEEN CHOSEN ABOVE.

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 (125)   _____%     _____%     NEUBERGER BERMAN ADVISERS MANAGEMENT TRUST
                                                                  Mid-Cap Growth Division (241)                    _____%     ____%
AIM VARIABLE INSURANCE FUNDS
AIM V.I. International Growth Division (126)_____%     _____%     PIMCO VARIABLE INSURANCE TRUST
AIM V.I. Premier Equity Division (127)      _____%     _____%     PIMCO Real Return Division (243)                 _____%     _____%
                                                                  PIMCO Short-Term Division (242)                  _____%     _____%
AMERICAN CENTURY VARIABLE PORTFOLIOS, INC.                        PIMCO Total Return Division (244)                _____%     _____%
VP Value Division (224)                     _____%     _____%
                                                                  PUTNAM VARIABLE TRUST
AYCO SERIES TRUST                                                 Putnam VT Diversified Income Division (137)      _____%     _____%
Ayco Growth Division (228)                  _____%     _____%     Putnam VT Growth and Income Division (138)       _____%     _____%
                                                                  Putnam VT Int'l Growth and Income Division (139) _____%     _____%
CREDIT SUISSE TRUST
Small Cap Growth Division (247)             _____%     _____%     SAFECO RESOURCE SERIES TRUST
                                                                  Equity Division (140)                            _____%     _____%
DREYFUS INVESTMENT PORTFOLIOS                                     Growth Opportunities Division (141)              _____%     _____%
MidCap Stock Division (229)                 _____%     _____%
                                                                  SUNAMERICA SERIES TRUST
DREYFUS VARIABLE INVESTMENT FUND                                  SunAmerica Balanced Division (252)               _____%     _____%
Quality Bond Division (132)                 _____%     _____%     Aggressive Growth Division (253)                 _____%     _____%
Small Cap Division (133)                    _____%     _____%
                                                                  THE UNIVERSAL INSTITUTIONAL FUNDS, INC.
FIDELITY VARIABLE INSURANCE PRODUCTS FUND                         Equity Growth Division (135)                     _____%     _____%
VIP Asset Manager Division (233)            _____%     _____%     High Yield Division (136)                        _____%     _____%
VIP Contrafund Division (232)               _____%     _____%
VIP Equity-Income Division (230)            _____%     _____%     VALIC COMPANY I
VIP Growth Division (231)                   _____%     _____%     International Equities Division (128)            _____%     _____%
                                                                  Mid Cap Index Division (129)                     _____%     _____%
FRANKLIN TEMPLETON VARIABLE INSURANCE PRODUCTS TRUST              Money Market I Division (130)                    _____%     _____%
Franklin U.S. Government Division (248)     _____%     _____%     Nasdaq-100 Index Division (225)                  _____%     _____%
Mutual Shares Securities Division (249)     _____%     _____%     Science & Technology Division (227)              _____%     _____%
Templeton Foreign Securities Division (250) _____%     _____%     Small Cap Index Division (226)                   _____%     _____%
                                                                  Stock Index Division (131)                       _____%     _____%
JANUS ASPEN SERIES
Aggressive Growth Division (236)            _____%     _____%     VANGUARD VARIABLE INSURANCE FUND
International Growth Division (234)         _____%     _____%     High Yield Bond Division (245)                   _____%     _____%
Worldwide Growth Division (235)             _____%     _____%     REIT Index Division (246)                        _____%     _____%

J.P. MORGAN SERIES TRUST II                                       VAN KAMPEN LIFE INVESTMENT TRUST
JPMorgan Small Company Division (237)       _____%     _____%     Growth & Income Division (251)                   _____%     _____%
                                                                  OTHER: ____________________________              _____%     _____%
MFS VARIABLE INSURANCE TRUST                                                                                        100%       100%
MFS Capital Opportunities Division (239)    _____%     _____%
MFS Emerging Growth Division (134)          _____%     _____%
MFS New Discovery Division (240)            _____%     _____%
MFS Research Division (238)                 _____%     _____%
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L8992-97 REV 0600                                                                                                       Page  1 of 3
                                                                                                                                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)
               ________________________________________________________ ________________________________________

                                              PREMIUM                                                                 PREMIUM
                                             ALLOCATION                                                              ALLOCATION
                                             __________                                                              __________

AIM VARIABLE INSURANCE FUNDS                                    NEUBERGER BERMAN ADVISERS MANAGEMENT TRUST
AIM V.I. International Growth Division (126)$__________         Mid-Cap Growth Division (241)                       $__________
AIM V.I. Premier Equity Division (127)      $__________
                                                                PIMCO VARIABLE INSURANCE TRUST
AMERICAN CENTURY VARIABLE PORTFOLIOS, INC.                      PIMCO Real Return Division (243)                    $__________
VP Value Division (224)                     $__________         PIMCO Short-Term Division (242)                     $__________
                                                                PIMCO Total Return Division (244)                   $__________
AYCO SERIES TRUST
Ayco Growth Division (228)                  $__________         PUTNAM VARIABLE TRUST
                                                                Putnam VT Diversified Income Division (137)         $__________
CREDIT SUISSE TRUST                                             Putnam VT Growth and Income Division (138)          $__________
Small Cap Growth Division (247)             $__________         Putnam VT Int'l Growth and Income Division (139)    $__________

DREYFUS INVESTMENT PORTFOLIOS                                   SAFECO RESOURCE SERIES TRUST
MidCap Stock Division (229)                 $__________         Equity Division (140)                               $__________
                                                                Growth Opportunities Division (141)                 $__________
DREYFUS VARIABLE INVESTMENT FUND
Quality Bond Division (132)                 $__________         SUNAMERICA SERIES TRUST
Small Cap Division (133)                    $__________         SunAmerica Balanced Division (252)                  $__________
                                                                Aggressive Growth Division (253)                    $__________
FIDELITY VARIABLE INSURANCE PRODUCTS FUND
VIP Asset Manager Division (233)            $__________         THE UNIVERSAL INSTITUTIONAL FUNDS, INC.
VIP Contrafund Division (232)               $__________         Equity Growth Division (135)                        $__________
VIP Equity-Income Division (230)            $__________         High Yield Division (136)                           $__________
VIP Growth Division (231)                   $__________
                                                                VALIC COMPANY I
FRANKLIN TEMPLETON VARIABLE INSURANCE PRODUCTS TRUST            International Equities Division (128)               $__________
Franklin U.S. Government Division (248)     $__________         Mid Cap Index Division (129)                        $__________
Mutual Shares Securities Division (249)     $__________         Nasdaq-100 Index Division (225)                     $__________
Templeton Foreign Securities Division (250) $__________         Science & Technology Division (227)                 $__________
                                                                Small Cap Index Division (226)                      $__________
JANUS ASPEN SERIES                                              Stock Index Division (131)                          $__________
Aggressive Growth Division (236)            $__________
International Growth Division (234)         $__________         VANGUARD VARIABLE INSURANCE FUND
Worldwide Growth Division (235)             $__________         High Yield Bond Division (245)                      $__________
                                                                REIT Index Division (246)                           $__________
J.P. MORGAN SERIES TRUST II
JPMorgan Small Company Division (237)       $__________         VAN KAMPEN LIFE INVESTMENT TRUST
                                                                Growth & Income Division (251)                      $__________
MFS VARIABLE INSURANCE TRUST
MFS Capital Opportunities Division (239)    $__________         OTHER: ____________________________                 $__________
MFS Emerging Growth Division (134)          $__________
MFS New Discovery Division (240)            $__________
MFS Research Division (238)                 $__________
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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
               United States Internal Revenue Code, there may be potentially adverse U.S. 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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L8992-97 REV 0600                                                                                                        Page 2 of 3
                                                                                                                                0502
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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.

                      [    ]  INITIAL HERE TO DECLINE THE ABOVE TELEPHONE AUTHORIZATION.
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SUITABILITY
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ALL QUESTIONS MUST    1. Have you, the Proposed Insured or Owner (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 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?                                           [_] yes  [_] no

                         b. 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

                         c. THE POLICY IS DESIGNED TO PROVIDE LIFE INSURANCE COVERAGE AND TO ALLOW FOR THE
                            ACCUMULATION OF VALUES IN THE SEPARATE ACCOUNT?                                          [_] 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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YOUR SIGNATURE
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SIGNATURES            Signed at (city, state)
                      ______________________________________________________________________________________________________________

                      Print name of Broker/Dealer
                      ______________________________________________________________________________________________________________

                      X Registered representative                              State license #              Date
                      ________________________________________________________ ____________________________ ________________________

                      X Primary proposed insured                                                            Date
                      _____________________________________________________________________________________ ________________________

                      X Owner                                                                               Date
                      _____________________________________________________________________________________ ________________________
                      (if different from Proposed Insured)

                      X Joint Owner                                                                         Date
                      _____________________________________________________________________________________ ________________________
                      (if applicable)

____________________________________________________________________________________________________________________________________
L8992-97 REV 0600                                                                                                        Page 3 of 3
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                                                                   EXHIBIT 10(e)

            SERVICE REQUEST

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

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PLATINUM INVESTOR--FIXED OPTION                                 MFS Variable Insurance Trust
                                                                ----------------------------
.. Division 125 - AGL Declared Fixed Interest Account
                                                                . Division 239 - MFS Capital Opportunities
PLATINUM INVESTOR--VARIABLE DIVISIONS
                                                                . Division 134 - MFS Emerging Growth
AIM Variable Insurance Funds
----------------------------                                    . Division 240 - MFS New Discovery

.. Division 126 - AIM V.I. International Growth                  . Division 238 - MFS Research

.. Division 127 - AIM V.I. Premier Equity                        Neuberger Berman Advisers Management Trust
                                                                ------------------------------------------
American Century Variable Portfolios, Inc.
------------------------------------------                      . Division 241 - Mid-Cap Growth

.. Division 224 - VP Value                                       PIMCO Variable Insurance Trust
                                                                ------------------------------
Ayco Series Trust
-----------------                                               . Division 243 - PIMCO Real Return

.. Division 228 - Ayco Growth                                    . Division 242 - PIMCO Short-Term

Credit Suisse Trust                                             . Division 244 - PIMCO Total Return
-------------------
                                                                Putnam Variable Trust
.. Division 247 - Small Cap Growth                               ---------------------

Dreyfus Investment Portfolios                                   . Division 137 - Putnam VT Diversified Income
-----------------------------
                                                                . Division 138 - Putnam VT Growth and Income
.. Division 229 - MidCap Stock
                                                                . Division 139 - Putnam VT Int'l Growth and Income
Dreyfus Variable Investment Fund
--------------------------------                                SAFECO Resource Series Trust
                                                                ----------------------------
.. Division 132 - Quality Bond
                                                                . Division 140 - Equity
.. Division 133 - Small Cap
                                                                . Division 141 - Growth Opportunities
Fidelity Variable Insurance Products Fund
-----------------------------------------                       SunAmerica Series Trust
                                                                -----------------------
.. Division 233 - VIP Asset Manager
                                                                . Division 253 - Aggressive Growth
.. Division 232 - VIP Contrafund
                                                                . Division 252 - SunAmerica Balanced
.. Division 230 - VIP Equity-Income
                                                                The Universal Institutional Funds, Inc.
.. Division 231 - VIP Growth                                     ---------------------------------------

Franklin Templeton Variable Insurance Products Trust            . Division 135 - Equity Growth
----------------------------------------------------
                                                                . Division 136 - High Yield
.. Division 248 - Franklin U.S. Government
                                                                VALIC Company I
.. Division 249 - Mutual Shares Securities                       ---------------

.. Division 250 - Templeton Foreign Securities                   . Division 128 - International Equities

Janus Aspen Series                                              . Division 129 - Mid Cap Index
------------------
                                                                . Division 130 - Money Market I
.. Division 236 - Aggressive Growth
                                                                . Division 225 - Nasdaq-100 Index
.. Division 234 - International Growth
                                                                . Division 227 - Science & Technology
.. Division 235 - Worldwide Growth
                                                                . Division 226 - Small Cap Index
J.P. Morgan Series Trust II
---------------------------                                     . Division 131 - Stock Index

.. Division 237 - JPMorgan Small Company                         Vanguard Variable Insurance Fund
                                                                --------------------------------

                                                                . Division 245 - High Yield Bond

                                                                . Division 246 - REIT Index

                                                                Van Kampen Life Investment Trust
                                                                --------------------------------
                                                                . Division 142 - Growth & Income

L 8993 Rev 0302
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[LOGO] AMERICAN                                                                                              VARIABLE UNIVERSAL LIFE
         | GENERAL                                                                                         INSURANCE SERVICE REQUEST

                                                                                                COMPLETE AND RETURN THIS REQUEST TO:
                                                                                                  Variable Universal Life Operations
AMERICAN GENERAL LIFE INSURANCE COMPANY ("AGL")                                                PO Box 4880 . Houston, TX. 77210-4880
Member of American International Group, Inc.           (888) 325-9315 or Hearing Impaired (TDD) (888) 436-5258 . Fax: (877) 445-3098
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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                     |
                                  | Change Name From: (First, Middle, Last)               Change Name To: (First, Middle, Last)
Complete this section if the name | __________________________________________________    _________________________________________
of the Insured, Owner, Payor or   |
 Beneficiary has changed. (Please | Reason for Change: (Circle One) Marriage Divorce Correction Other (Attach copy of legal proof)
 note, this does not change the   |
    Insured, Owner, Payor or      |
   Beneficiary designation)       |
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  [_]  CHANGE IN               3. | INVESTMENT DIVISION               PREM % DED %   INVESTMENT DIVISION              PREM %  DED %
       ALLOCATION                 | (125) - AGL Declared Fixed                       Neuberger Berman Advisers Management Trust
       PERCENTAGES                |         Interest Account          _____% _____%  ------------------------------------------
                                  |                                                  (241) Mid-Cap Growth             _____%  _____%
 Use this section to indicate     | AIM Variable Insurance Funds
    how premiums or monthly       | ----------------------------                     PIMCO Variable Insurance Trust
    deductions are to be          | (126) AIM V.I. International                     ------------------------------
 allocated. Total allocation in   |       Growth                      _____% _____%  (243) PIMCO Real Return          _____%  _____%
    each column must equal        | (127) AIM V.I. Premier Equity     _____% _____%  (242) PIMCO Short-Term           _____%  _____%
        100%; whole               |                                                  (244) PIMCO Total Return         _____%  _____%
       numbers only.              | American Century Variable Portfolios, Inc.
                                  | ------------------------------------------       Putnam Variable Trust
                                  | (224) VP Value                    _____% _____%  ---------------------
                                  |                                                  (137) Putnam VT Diversified
                                  | Ayco Series Trust                                      Income                     _____%  _____%
                                  | -----------------                                (138) Putnam VT Growth and
                                  | (228) Ayco Growth                 _____% _____%        Income                     _____%  _____%
                                  |                                                  (139) Putnam VT Int'l Growth
                                  | Credit Suisse Trust                                    and Income                 _____%  _____%
                                  | -------------------
                                  | (247) Small Cap Growth            _____% _____%  SAFECO Resource Series Trust
                                  |                                                  ----------------------------
                                  | Dreyfus Investment Portfolios                    (140) Equity                     _____%  _____%
                                  | -----------------------------                    (141) Growth Opportunities       _____%  _____%
                                  | (229) MidCap Stock
                                  |                                                  SunAmerica Series Trust
                                  | Dreyfus Variable Investment Fund                 -----------------------
                                  | --------------------------------                 (253) Aggressive Growth          _____%  _____%
                                  | (132) Quality Bond                _____% _____%  (252) SunAmerica Balanced        _____%  _____%
                                  | (133) Small Cap                   _____% _____%
                                  |                                                  The Universal Institutional Funds, Inc.
                                  | Fidelity Variable Insurance Products Fund        ---------------------------------------
                                  | -----------------------------------------        (135) Equity Growth              _____%  _____%
                                  | (233) VIP Asset Manager           _____% _____%  (136) High Yield                 _____%  _____%
                                  | (232) VIP Contrafund              _____% _____%
                                  | (230) VIP Equity Income           _____% _____%  VALIC Company I
                                  | (231) VIP Growth                  _____% _____%  ---------------
                                  |                                                  (128) International Equities     _____%  _____%
                                  | Franklin Tempelton Variable Insurance            (129) Mid Cap Index              _____%  _____%
                                  | Products Trust                                   (130) Money Market I             _____%  _____%
                                  | --------------                                   (225) Nasdaq-100 Index           _____%  _____%
                                  | (248) Franklin U.S. Government    _____% _____%  (227) Science & Technology       _____%  _____%
                                  | (249) Mutual Shares Securities    _____% _____%  (226) Small Cap Index            _____%  _____%
                                  | (250) Templeton Foreign Securities_____% _____%  (131) Stock Index                _____%  _____%
                                  |
                                  | Janus Aspen Series                               Vanguard Variable Insurance Fund
                                  | ------------------                               --------------------------------
                                  | (236) Aggressive Growth           _____% _____%  (245) High Yield Bond            _____%  _____%
                                  | (234) International Growth        _____% _____%  (246) REIT Index                 _____%  _____%
                                  | (235) Worldwide Growth            _____% _____%
                                  |                                                  Van Kampen Life Investment Trust
                                  | J.P. Morgan Series Trust II                      --------------------------------
                                  | ---------------------------                      (142) Growth & Income            _____%  _____%
                                  | (237) JPMorgan Small Company      _____% _____%
                                  |                                                  Other: _________________________ _____%  _____%
                                  | MFS Variable Insurance Trust                     ______                            100%    100%
                                  | ----------------------------
                                  | (239) MFS Capital Opportunities   _____% _____%
                                  | (134) MFS Emerging Growth         _____% _____%
                                  | (240) MFS New Discovery           _____% _____%
                                  | (238) MFS Research                _____% _____%
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L 8993 REV 0302                                                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 Bank
  Use this section to change the  |                                                                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 S25 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     | AIM Variable Insurance Funds                    Neuberger Berman Advisers Management Trust
 placed in one or more of the     | -----------------------------                   ------------------------------------------
   Divisions listed. The AGL      | (126) AIM V.I. International Growth  $________  (241) Mid-Cap Growth                   $________
Declared Fixed Interest Account   | (127) AIM V.I. Premier Equity        $________
is not available for Dollar Cost  |                                                 PIMCO Variable Insurance Trust
Averaging. Please refer to the    | American Century Variable Portfolios, Inc.      ------------------------------
 prospectus for more information  | ------------------------------------------      (243) PIMCO Real Return                $________
   on the Dollar Cost Averaging   | (224) VP Value                       $________  (242) PIMCO Short-Term                 $________
            Option.               |                                                 (244) PIMCO Total Return               $________
                                  | Ayco Series Trust
                                  | -----------------                               Putnam Variable Trust
                                  | (228) Ayco Growth                    $________  ---------------------
                                  |                                                 (137) Putnam VT Diversified Income     $________
                                  | Credit Suisse Trust                             (138) Putnam VT Growth and Income      $________
                                  | -------------------                             (139) Putnam VT Int'l
                                  | (247) Small Cap Growth               $________        Growth and Income                $________
                                  |
                                  | Dreyfus Investment Portfolios                    SAFECO Resource Series Trust
                                  | -----------------------------                    ----------------------------
                                  | (229) MidCap Stock                   $________   (140) Equity                          $________
                                  |                                                  (141) Growth Opportunities            $________
                                  | Dreyfus Variable Investment Fund
                                  | --------------------------------                 SunAmerica Series Trust
                                  | (132) Quality Bond                   $________   -----------------------
                                  | (133) Small Cap                      $________   (253) Aggressive Growth               $________
                                  |                                                  (252) SunAmerica Balanced             $________
                                  | Fidelity Variable Insurance Products Fund
                                  | -----------------------------------------        The Universal Institutional Funds, Inc.
                                  | (233) VIP Asset Manager                          ---------------------------------------
                                  | (232) VIP Contrafund                 $________   (135) Equity Growth                   $________
                                  | (230) VIP Equity-Income              $________   (136) High Yield                      $________
                                  | (231) VIP Growth                     $________
                                  |                                                  VALIC Company I
                                  | Franklin Templeton Variable Insurance            ---------------
                                  | -------------------------------------            (128) International Equities          $________
                                  | Products Trust                                   (129) Mid Cap Index                   $________
                                  | --------------                                   (225) Nasdaq-100 Index                $________
                                  | (248) Franklin U.S. Government       $________   (227) Science & Technology            $________
                                  | (249) Mutual Shares Securities       $________   (226) Small Cap Index                 $________
                                  | (250) Templeton Foreign Securities   $________   (131) Stock Index                     $________
                                  |
                                  | Janus Aspen Series                               Vanguard Variable Insurance Fund
                                  | ------------------                               --------------------------------
                                  | (236) Aggressive Growth              $________   (245) High Yield Bond                 $________
                                  | (234) International Growth           $________   (246) REIT Index                      $________
                                  | (235) Worldwide Growth               $________
                                  |                                                  Van Kampen Life Investment Trust
                                  | J.P. Morgan Series Trust II                      --------------------------------
                                  | ---------------------------                      (142) Growth & Income                 $________
                                  | (237) JPMorgan Small Company         $________
                                  |                                                  Other: _________________________      $________
                                  | MFS Variable Insurance Trust                     ------
                                  | ----------------------------
                                  | (239) MFS Capital Opportunities      $________
                                  | (134) MFS Emerging Growth            $________
                                  | (240) MFS New Discovery              $________
                                  | (238) MFS Research                   $________
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L 8993 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.        | _______%: ___________________________________        _______%: ________________________________
  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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  [_]  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) AND 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 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 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. | Name of 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             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 ____________________________.
Withdrawals from the AGL Declared |
   Fixed Interest Account are     | Transfer $_______ or _______% from ____________________________ to ____________________________.
  limited to 60 days after the    |
policy anniversary and to no more | Transfer $_______ or _______% from ____________________________ to ____________________________.
 than 25% of the total unloaned   |
value of the AGL Declared Fixed   | Transfer $_______ or _______% from ____________________________ to ____________________________.
Interest Account on the policy    |
anniversary. If a transfer causes | Transfer $_______ or _______% from ____________________________ to ____________________________.
  the balance in any division to  |
  drop below $500, AGL reserves   | Transfer $_______ or _______% from ____________________________ to ____________________________.
      the right to transfer       |
 the remaining balance. Amounts   | Transfer $_______ or _______% from ____________________________ to ____________________________.
    to be transferred should be   |
indicated in dollar or percentage | Transfer $_______ or _______% from ____________________________ to ____________________________.
    amounts, maintaining          |
   consistency throughout.        | Transfer $_______ or _______% from ____________________________ to ____________________________.
                                  |
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L 8993 Rev0302                                                      PAGE 4 OF 5
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 [_]  REQUEST FOR             11. |
      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 AGL 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.    | ________________________________________________________________________________________________
                                  |
                                  | ________________________________________________________________________________________________
                                  |
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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 it 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/            13. | 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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L 8993 Rev0302                                                 PAGE 5 OF 5
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