EXHIBIT 10(f)
SERVICE REQUEST
THE ONE(R) VUL Solution(SM)
- ----------------------------
AMERICAN GENERAL LIFE
- --------------------------------------------------------------------------------
The One VUL Solution--Variable Divisions
AIM Variable Insurance Funds, Inc.
- ----------------------------------------
. Division 59 - AIM V.I. Capital Appreciation Fund
. Division 60 - AIM V.I. Government Securities Fund
. Division 61 - AIM V.I. High Yield Fund
. Division 62 - AIM V.I. International Equity Fund
American General Series Portfolio Company
- -----------------------------------------
. Division 63 - Money Market Fund
Kemper Variable Series
- ----------------------
. Division 64 - Kemper International Portfolio
. Division 65 - Kemper Small Cap Value Portfolio
MFS(R) Variable Insurance Trust
- -------------------------------
. Division 66 - MFS Growth With Income Series
Oppenheimer Variable Account Funds
- ----------------------------------
. Division 67 - Oppenheimer High Income Fund/VA
One Group(TM) Investment Trust
- ------------------------------
. Division 68 - One Group Investment Trust Diversified Equity Portfolio
. Division 69 - One Group Investment Trust Equity Index Portfolio
. Division 70 - One Group Investment Trust Government Bond Portfolio
. Division 71 - One Group Investment Trust Large Cap Growth Portfolio
. Division 72 - One Group Investment Trust Mid Cap Growth Portfolio
Putnam Variable Trust
- ---------------------
. Division 73 - Putnam VT Visa Fund
Franklin Templeton Variable Insurance Products Trust
- ----------------------------------------------------
. Division 74 - Franklin Small Cap Fund
Templeton Variable Products Series Fund
- ---------------------------------------
. Division 75 - Templeton Developing Markets Fund
Van Kampen Life Investment Trust
- --------------------------------
. Division 76 - Emerging Growth Portfolio
AMERICAN GENERAL LIFE INSURANCE COMPANY ("AGL")
Complete and return this request to: -----------------------------------------------
Variable Universal Life Operations A Subsidiary of American General Corporation AMERICAN
PO Box 4880 Houston, TX 77210-4880 ----------------------------------------------- |GENERAL
(888) 436-5255 or Houston, Texas |Financial Group
Hearing Impaired (TDD) (888) 436-5258
Toll Free Fax: (887) 445-3098 VARIABLE UNIVERSAL LIFE INSURANCE SERVICE REQUEST
- ------------------------------------------------------------------------------------------------------------------------------------
[ ] POLICY 1.| POLICY #:___________________________________________________ INSURED:_________________________________
IDENTIFICATION |
| ADDRESS:________________________________________________________________________ New Address (yes)(no)
COMPLETE THIS SECTION |
FOR ALL REQUESTS. | Primary Owner (If other than 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)
- -----------------------------------------------------------------------------------------------------------------------------------
[ ] NAME 2.|
CHANGE | Change Name Of: (Circle One) Insured Owner Payor Beneficiary
|
Complete this section if | Change Name From: (First, Middle, Last) Change Name To: (First, Middle, Last)
the name of the Insured, |
Owner, Payor or Beneficiary| _________________________________________ _________________________________________________
has changed. (Please note,|
this does not change the |
Insured, Owner, Payor or | Reason for Change: (Circle One) Marriage Divorce Correction Other (Attach copy of legal proof)
Beneficiary designation) |
- -----------------------------------------------------------------------------------------------------------------------------------
[ ] MODE OF PREMIUM 3.|
PAYMENT/BILLING | Indicate frequency and premium amount desired: $______ Annual $______ Semi-Annual $_______ Quarterly
METHOD CHANGE |
| $______ Monthly (Bank Draft Only)
Use this section to change |
the billing frequency and/ | Indicate billing method desired:_____ Direct Bill ______ Pre-Authorized Bank Draft (attach a Bank Draft
or method of premium pay- | Authorization Form and "Void" Check)
ment. Note, however, that |
AGL will not bill you on a | Start Date: ______/______/_____
direct monthly basis. Refer|
to your policy and its |
related prospectus for |
further information |
concerning minimum premiums|
and billing options. |
- -----------------------------------------------------------------------------------------------------------------------------------
[ ] DOLLAR COST 4.| Designate the day of the month for transfers:_________(choose a day from 1-28)
AVERAGING |
($5,000 minimum initial | Frequency of transfers (check one): _______Monthly _______Quarterly ______Semi-Annually _____Annually
accumulation value) An |
amount may be deducted | I want: $___________($100 minimum) taken from the Money Market Division (63) and transferred to the
periodically from the | following Divisions:
Money Market Division and |
placed in one or more of | AIM Variable Insurance Funds, Inc. One Group Investment Trust
the Divisions listed. This | $_________(59) AIM V.I. Capital Appreciation $________(68) One Group Investment Trust Diversified
option is not available | $_________(60) AIM V.I. Government Securities Equity
while the Automatic Re- | $_________(61) AIM V.I. High Yield $________(69) One Group Investment Trust Equity
balancing option is in use.| $_________(62) AIM V.I. International Equity Index
Please refer to the pros- | Kemper Variable Series $________(70) One Group Investment Trust Government
pectus for more infor- | $_________(64) Kemper International Bond
mation on the Dollar Cost | $_________(65) Kemper Small Cap Value $________(71) One Group Investment Trust Large
Averaging Option. | MFS(R) Variable Insurance Trust Cap Growth
| $_________(66) MFS Growth With Income $________(72) One Group Investment Trust Mid Cap
| Oppenheimer Variable Account Funds Growth
| $_________(67) Oppenheimer High Income Putnam Variable Trust
| $________(73) Putnam VT Vista
| Franklin Templeton Variable Insurance Products
| Trust
| $________(74) Franklin Small Cap Investments
| Templeton Variable Products Series Fund
| $________(75) Templeton Developing Markets
| Van Kampen Life Investment Trust
| $________(76) Emerging Growth
|
| ________INITIAL HERE TO REVOKE DOLLAR COST AVERAGING ELECTION.
- -----------------------------------------------------------------------------------------------------------------------------------
VUL 0008 PAGE 2 OF 4
- ------------------------------------------------------------------------------------------------------------------------------------
[ ] TELEPHONE 5.| I(/we if Joint Owners) hereby authorize AGL to act on telephone instructions to transfer values among
PRIVILEGE | Divisions and to change allocations for future purchase payments and monthly deductions.
AUTHORIZATION |
|
Complete this section if | Initial the designation you prefer:
you are applying for or |
revoking current telephone| __________Policy Owner(s) only--If Joint Owners, either one acting independently.
privileges. | __________Policy Owner(s) or 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.
- -----------------------------------------------------------------------------------------------------------------------------------
[ ] CORRECT AGE 6.|
| Name of Insured for whom this correction is submitted:___________________________________
|
Use this section to correct| Correct DOB: ________/________/________
the age of any person |
covered under this policy. |
Proof of the correct date |
of birth must accompany |
this request. |
- -----------------------------------------------------------------------------------------------------------------------------------
[ ] TRANSFER OF 7.| (Division Name or Number) (Division Name or Number)
ACCUMULATED VALUES |
|
|
Use this section if you |
want to move money between | Transfer $________ or _______% from_______________________________to__________________________________
divisions. If a transfer |
causes the balance in any | Transfer $________ or _______% from_______________________________to__________________________________
division to drop below |
$500, AGL reserves | Transfer $________ or _______% from_______________________________to__________________________________
the right to transfer |
the remaining balance. | Transfer $________ or _______% from_______________________________to__________________________________
Amounts to be transferred |
should be indicated in | Transfer $________ or _______% from_______________________________to__________________________________
dollar or percentage |
amounts, maintaining | Transfer $________ or _______% from_______________________________to__________________________________
consistency throughout. |
There is a $500 minimum | Transfer $________ or _______% from_______________________________to__________________________________
amount for division |
transfers. |
-----------------------------------------------------------------------------------------------------------------------------------
[ ] CHANGE IN 8.| INVESTMENT DIVISION PREM % DED % INVESTMENT DIVISION PREM % DED %
ALLOCATION | AIM Variable Insurance Funds, Inc. One Group Investment Trust
PERCENTAGES | (59) AIM V.I. Capital Appreciation ______ ______ (68) One Group Investment Trust Diversified
| (60) AIM V.I. Government Securities ______ ______ Equity ______ ______
Use this section to | (61) AIM V.I. High Yield ______ ______ (69) One Group Investment Trust Equity
indicate how premiums or | (62) AIM V.I. International Equity ______ ______ Index ______ ______
monthly deductions are to | American General Series Portfolio Company (70) One Group Investment Trust Government
be allocated. Total | (63) Money Market ______ ______ Bond ______ ______
allocation in each | Kemper Variable Series (71) One Group Investment Trust Large Cap
column must equal 100%; | (64) Kemper International ______ ______ Growth ______ ______
whole numbers only | (65) Kemper Small Cap Value ______ ______ (72) One Group Investment Trust Mid Cap
| MFS Variable Insurance Trust Growth ______ ______
| (66) MSF Growth With Income ______ ______ Putnam Variable Trust
| Oppenheimer Variable Account Funds (73) Putnam VT Vista ______ ______
| (67) Oppenheimer High Income ______ ______ Franklin Templeton Variable Insurance
| Products Trust
| (74) Franklin Small Cap ______ ______
| Templeton Variable Products Series Fund
| (75) Templeton Developing Markets
| ______ ______
| Van Kampen Life Investment Trust
| (76) Emerging Growth ______ ______
- -----------------------------------------------------------------------------------------------------------------------------------
[ ] AUTOMATIC 9.| Indicate frequency: _______ Quarterly ______ Semi-Annually ______ Annually
REBALANCING |
| (Division Name or Number) (Division Name or Number)
|
($5,000 minimum | _________% _______________________________________: _________% __________________________________:
accumulation value) Use |
this section to apply for | _________% _______________________________________: _________% __________________________________:
or make changes to |
Automatic Rebalancing of | _________% _______________________________________: _________% __________________________________:
the 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.
- -----------------------------------------------------------------------------------------------------------------------------------
VUL 0008 PAGE 3 OF 4
- ------------------------------------------------------------------------------------------------------------------------------------
|
- -----------------------------------------------------------------------------------------------------------------------------------
[ ] REQUEST FOR 10.| _________I request a partial surrender of $_________ or %_________ of the net cash surrender value.
PARTIAL |
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 | Unless you direct otherwise below, proceeds are allocated according to the deduction allocation
or policy loan. | percentages in effect, if available; otherwise they are taken pro-rata from the Divisions in use.
If applying for a partial |
surrender, be sure to |
complete the Notice of | ______________________________________________________________________________________________________
Withholding section of this|
Service Request in addition| ______________________________________________________________________________________________________
to this section. |
There will be a charge not | ______________________________________________________________________________________________________
to exceed 2% of the amount |
withdrawn or $25. The min- | ______________________________________________________________________________________________________
imum surrender amount is |
$500. Refer to your policy | ______________________________________________________________________________________________________
and its related prospectus |
for further information. |
- ------------------------------------------------------------------------------------------------------------------------------------
[ ] NOTICE OF 11.| The taxable portion of the distribution you receive from your variable universal life insurance policy
WITHHOLDING | is subject to federal income tax withholding unless you elect not to have withholding apply.
| Withholding of state income tax may also be required by your state of residence. You may elect not to
Complete this section if | have withholding apply by checking the appropriate box below. If you elect not to have withholding
you have applied for a | apply to your distribution or if you do not have enough income tax withheld, you may be responsible for
partial surrender in | payment of estimated tax. You may incur penalties under the estimated tax rules, if your withholding
Section 10. | 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.
|
- ------------------------------------------------------------------------------------------------------------------------------------
[ ] LOST POLICY 12.|
WITHHOLDING | I/we hereby certify that the policy of insurance for the listed policy has been _________LOST
| __________DESTROYED ________OTHER.
Complete this section if |
applying for a Certificate | Unless I/we have directed cancellation of the policy, I/we request that a:
of Insurance or duplicate |
policy to replace a lost | _______ Certificate of Insurance at no charge
or misplaced policy. If a |
full duplicate policy is | _______ Full Duplicate policy at a charge of $25
being requested, a check |
or money order for $25 | be issued to me/us. If the original policy is located, I/we will return the Certificate or
payable to AGL must be | duplicate policy to AGL for cancellation.
submitted with this |
request. |
- ------------------------------------------------------------------------------------------------------------------------------------
[ ] AFFIRMATION/ 13.| CERTIFICATION: Under penalties of perjury, I certify: (1) that the number shown on this form is my
SIGNATURE | correct taxpayer identification number and; (2) that I am not subject to backup withholding under
| Section 3406(a)(1)(C) of the Internal Revenue Code. The Internal Revenue Service does not require your
Complete this section for | consent to any provision of this document other than the certification required to avoid backup
ALL requests. | withholding.
|
| Dated at __________________________________ this _________ day of ________________________, ________.
| (MONTH) (YEAR)
|
| 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
- -----------------------------------------------------------------------------------------------------------------------------------
PAGE 4 OF 4