EXHIBIT 10(f)
SERVICE REQUEST
K E Y
L E G A C Y
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Plus
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AMERICAN GENERAL LIFE
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KEY LEGACY PLUS--VARIABLE DIVISIONS
AIM Variable Insurance Funds, Inc.
* Division 81 - AIM V.I. International Equity Fund
American Century Variable Portfolios, Inc.
* Division 82 - VP Value Fund
American General Series Portfolio Company
* Division 83 - Money Market Fund
MFS(R)-Variable Insurance Trust
* Division 84 - MFS Total Return Series
Neuberger Berman Advisers Management Trust
* Division 85 - Partners Portfolio
Oppenheimer Variable Account Funds
* Division 86 - Oppenheimer High Income Fund/VA
Putnam Variable Trust
* Division 87 - Putnam VT Diversified Income Fund
Franklin Templeton Variable Insurance Products Trust
* Division 88 - Franklin Small Cap Fund
Templeton Variable Products Series Fund
* Division 89 - Templeton International Fund
Van Kampen Life Investment Trust
* Division 90 - Emerging Growth Portfolio
Victory Variable Insurance Funds
* Division 91 - Diversified Stock Fund
* Division 92 - Investment Quality Bond Fund
* Division 93 - Small Cap Opportunity Fund
AMERICAN
AMERICAN GENERAL LIFE INSURANCE COMPANY ("AGL") | GENERAL
Complete and return this request to: ----------------------------------------------- | FINANCIAL GROUP
Variable Universal Life Operations A Subsidiary of American General Corporation
PO Box 4880 Houston, TX 77210-4880 -----------------------------------------------
(888) 436-4963 or Houston, Texas
Hearing Impaired (TDD): (888) 436-5258
Toll Free Fax: (877) 445-3098 VARIABLE UNIVERSAL LIFE INSURANCE SERVICE REQUEST
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[ ] 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)
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[ ] 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) |
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[ ] 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 frequence 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. |
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[ ] LOST POLICY 4.|
CERTIFICATE | I/we hereby certify that the policy of insurance for the listed policy has been ____LOST_____DESTROYED
| _____OTHER.
Complete this section if | Unless I/we have directed cancellation of the policy, I/we request that a:
applying for a Certificate |
of Insurance or duplicate | _________ Certificate of Insurance at no charge
policy to replace a lost or|
misplaced policy. If a full| _________ Full duplicate policy at a charge of $25
duplicate policy is being |
requested, a check or money| be issued to me/us. If the original policy is located, I/we will return the Certificate or duplicate
order for $25 payable to | policy to AGL for cancellation.
AGL must be submitted with|
this request. |
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[ ] DOLLAR COST 5.| 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 (83) and transferred to the
periodically from the | following Division(s):
Money Market Division and |
placed in one or more of | AIM Variable Insurance Funds, Inc. Franklin Templeton Variable Insurance Products Trust
the Divisions listed. | $_________(81) AIM V.I. International Equity $________(88) Franklin Small Cap
Please refer to the pros- | American Century Variable Portfolios, Inc. Templeton Variable Products Series Fund
pectus for more infor- | $_________(82) VP Value $________(89) Templeton International
mation on the Dollar Cost | MFS(R) Variable Insurance Trust Van Kampen Life Investment Trust
Averaging Option. | $_________(84) MFS Total Return Series $________(90) Emerging Growth
This option is not | Neuberger Berman Advisers Management Trust Victory Variable Insurance Funds
available while the | $_________(85) Partners Portfolio $________(91) Diversified Stock
Automatic Rebalancing | Oppenheimer Variable Account Funds $________(92) Investment Quality Bond
option is in use. | $_________(86) Oppenheimer High Income $________(93) Small Cap Opportunity
| Putnam Variable Trust
| $_________(87) Putnam VT Diversified Income
|
| ________INITIAL HERE TO REVOKE DOLLAR COST AVERAGING ELECTION.
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[ ] TELEPHONE 6.| 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.
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[ ] CORRECT AGE 7.|
| 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. |
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[ ] TRANSFER OF 8.| (Division Name or Number) (Division Name or Number)
ACCUMULATED VALUES |
|
| Transfer $________ or ______% from_______________________________to__________________________________
Use this section if you |
want to move money between | Transfer $________ or ______% from_______________________________to__________________________________
divisions. If a transfer |
causes the balance in any | Transfer $________ or ______% from_______________________________to__________________________________
division to drop below |
$500, AGL reserves the | Transfer $________ or ______% from_______________________________to__________________________________
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. | Transfer $________ or ______% from_______________________________to__________________________________
|
| Transfer $________ or ______% from_______________________________to__________________________________
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[ ] CHANGE IN 9.| INVESTMENT DIVISION PREM % DED % INVESTMENT DIVISION PREM % DED %
ALLOCATION | AIM Variable Insurance Funds, Inc. Putnam Variable Trust
PERCENTAGES | (81) AIM V.I. International Equity ______ ______ (87) Putnam VT Diversified Income
| American Century Variable Portfolios, Inc. ______ ______
Use this section to | (82) VP Value ______ ______ Franklin Templeton Variable Insurance
indicate how premiums or | American General Series Portfolio Company Products Trust
monthly deductions are to | (83) Money Market ______ ______ (88) Franklin Small Cap ______ ______
be allocated. Total | MFS(R) Variable Insurance Trust Templeton Variable Products Series Fund
allocation in each | (84) MFS Total Return Series ______ ______ (89) Templeton International ______ ______
column must equal 100%; | Neuberger Berman Advisers Management Trust Van Kampen Life Investment Trust
whole numbers only. | (85) Partners Portfolio ______ ______ (90) Emerging Growth ______ ______
| Oppenheimer Variable Account Funds Victory Variable Insurance Funds
| (86) Oppenheimer High Income ______ ______ (91) Diversified Stock ______ ______
(92) Investment Quality Bond ______ ______
(93) Small Cap Opportunity ______ ______
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AGLC 0092
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[ ] AUTOMATIC 10.| 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.
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[ ] REQUEST FOR 11.| _________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. If | percentages in effect, if available; otherwise they are taken pro-rata from the Variable Divisions
applying for a partial | in use.
surrender, be sure to |
complete the Notice of | ______________________________________________________________________________________________________
Withholding section of this|
Service Request in addition| ______________________________________________________________________________________________________
to this section. |
The minimum surrender | ______________________________________________________________________________________________________
amount is $500. There will |
be a charge not to exceed | ______________________________________________________________________________________________________
2% of the amount withdrawn |
or $25. | ______________________________________________________________________________________________________
Refer to your policy and |
its related prospectus for |
further information. |
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[ ] NOTICE OF 12.| 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 11. | 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.
|
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[ ] 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
|
|
|
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AGLC 0092