EXHIBIT 1.(5)(b)(i)

AMERICAN GENERAL LIFE INSURANCE COMPANY
Home Office: Houston, Texas
APPLICATION FOR LIFE INSURANCE

1. NAMES OF PERSONS PROPOSED FOR INSURANCE Sex Relationship Date of Birth Ins. Place of Height Weight
First Middle Last Mo Day Yr Age Birth Ft In
A. JOHN M DOE M Primary 1 - 1 - 62 35 TEXAS 5' 10" 175
Drivers Lic Num & State:____________________________ SS# ___________________
B.
Drivers Lic Num & State:____________________________ SS# ___________________
C.
D.

For child or family benefits, list only children who are natural or legally
adopted children of the Primary Proposed Insured or Spouse and who actually
reside at the address of the Primary Proposed Insured.
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2. PRESENT RESIDENCE OF PRIMARY PROPOSED INSURED
Address 123 MAIN ST.
City HOUSTON State TEXAS ZIP 77041
Telephone (713) 466-3800 No. of Yrs. 10
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3. OCCUPATION Proposed Insured A
Occupation BANKER Yrs. 10
Employer Name BANK ONE
Address ________________________________
City____________________________________State______Zip_______
Telephone (___)________________

PROPOSED INSURED B
Occupation ______________ Yrs. ___
Employer Name ____________________
Address ________________________________
City____________________________________State______Zip_______
Telephone (___)________________
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4. HAS PROPOSED INSURED A OR B USED TOBACCO IN ANY FORM IN THE PAST 24 MONTHS?
Proposed Insured A [ ] Yes [X] No
Proposed Insured B [ ] Yes [ ] No
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5. PLAN OF BASIC INSURANCE:
Amount
UNIVERSAL LIFE $ 25,000
-------------- ---------------
Planned Periodic Premium $______________
Lump Sum Payment $______________
Benefit Option: [ ] 1 - Level [ ] 2 - Increasing
Are you requesting Select Rates? [ ] Yes [ ] No
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6. ADDITIONAL BENEFITS TO BE ADDED Amount
[ ] Maturity Extension Rider - Death Benefit
[ ] Maturity Extension Rider - Accumulation Value
[ ] Terminal Illness Rider
[ ] Waiver of Premium/Waiver of Monthly Deduction
[ ] Waiver of Monthly Guarantee Premium
[ ] Accidental Death Benefit $______________
[ ] Spouse/Other Insured Rider $______________
[ ] FIB __________ Units CIB___________ Units
[ ] Additional Insurance Option $______________
[ ] Joint Insurance 4-Year Term $______________
[ ] First-to-die Term Rider $______________
[ ] Joint Term $______________
[ ] Joint ART A n B n $______________
[ ] Automatic Increase Rider _____________%
[ ] Return of Premium Death Benefit Option
[ ] Premium Assurance Rider
[ ] Other __________________________________ $______________
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7. PREMIUMS TO BE PAID
[ ] Automatic Bank Check [ ] Direct
[ ] List Bill or Government Allotment List Bill # ___________
Company __________________
[ ] Annually [ ] Semi-Annually [ ] Quarterly
Amount paid with application $ _______________ or None
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8. BENEFICIARY DESIGNATION PROPOSED INSURED A

Proposed Insured B

________________________________________________________________________
First Relationship
________________________________________________________________________
Second Relationship
________________________________________________________________________
Trust Name Date of Trust
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9. PREMIUM PAYOR
Name ___________________________________________________
Address _________________________________________________
City ______________________ State _________ ZIP _________
Relationship to Primary Proposed Insured ________________
SECONDARY PAYOR
Name ___________________________________________________
Address _________________________________________________
City ______________________ State _________ ZIP _________
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10. POLICYOWNER AND TAXPAYER IDENTIFICATION NUMBER (MUST BE COMPLETED)
Policyowner Name ________________________________________
Address _________________________________________________
City ______________________ State _________ ZIP _________
Social Security or Tax ID Number ________________________
Policyowner Date of Birth _______________________________
[ ] Insured [ ] Other Relationship ____________

CONTINGENT OWNER DESIGNATION
Contingent Policyowner Name _____________________________
Social Security or Tax ID Number ________________________
(Contingent Policyowner designation becomes effective upon the death
of the Primary Owner)
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11. INCLUDE AUTOMATIC PREMIUM LOAN IF AVAILABLE? [ ] Yes [ ] No
Home Office Endorsement Only. May not be used in any state where prohibited.
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L 8754-95 REV 897 -1-

12. HAS ANY PERSON PROPOSED FOR INSURANCE DURING THE LAST 12 MONTHS

a. had a heart attack, stroke, cancer, diabetes, or
disorder of the immune system? [ ] YES [ ] NO
b. been confined to a hospital or other health care
facility and/or been advised to have any diagnostic
test or surgery not yet performed? [ ] YES [ ] NO
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Temporary insurance is not available if there are any "yes" answers to
question number 1
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13. REPLACEMENTS, EXCHANGES, CONVERSIONS

If this is a replacement, required state replacement forms and disclosures
must be used. If state does not require Policy Comparison Form, you must
attach AGL Replacement Comparison Guide (L8726).

a. List below all Life Insurance policies in force and applied for in all
companies.

(Use explanations section on pg. 3 if necessary.)

Proposed Proposed Is Beneficiary
Insured Insured Year Coverage Amount Business or Replace
A B Company Issued Life ADB Personal Yes No

Proposed Insured
A B_D
Yes No Yes No

b. Is this insurance intended to be a 1035 tax-free exchange? [ ] [X] [ ] [ ]
c. Is this insurance intended to be a term conversion? [ ] [X] [ ] [ ]
d. Will this insurance replace, change, or use the cash value of any existing
insurance policy or annuity? [ ] [X] [ ] [ ]

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PART 2. UNDERWRITING INFORMATION

IMPORTANT: (QUESTIONS 1 & 2 MUST BE ANSWERED EVEN IF A MEDICAL EXAM WILL BE
PROVIDED)
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PROVIDE DETAILS TO ANY YES ANSWERS UNDER EXPLANATIONS ON PAGE 3

1. HAS ANY PROPOSED INSURED:
Proposed Insured
A B_D
Yes No Yes No

a. in the past 2 years flown in any type of
aircraft or plan to fly in the future, other
than as a passenger? [ ] [X] [ ] [ ]

(If "Yes" complete Military & Civilian Aviation Supplement.)

b. in the past 2 years participated or expect
to participate in any vehicle racing on land
or water, bobsledding, scuba or skin diving,
skydiving or parachuting, ultralight
aviation, or mountaineering? [ ] [X] [ ] [ ]

(If "Yes" complete Avocation Questionnaire.)

c. during the past 90 days submitted an
application for life insurance to any other
company or is any contemplated? [ ] [X] [ ] [ ]

d. ever had a life insurance application
modified, rated, declined, postponed,
withdrawn, canceled, or refused for renewal? [ ] [X] [ ] [ ]

e. any intention of traveling or residing
outside the United States or Canada within
the next 24 months [ ] [X] [ ] [ ]

f. during the past 3 years been refused a
driver's license, had a moving violation, or
been involved in 1 or more accidents? [ ] [X] [ ] [ ]

(If "Yes" give license number, issue state & details.)

g. ever used cocaine, barbiturates, heroin, or
other narcotic drugs, except as legally
prescribed by a physician? [ ] [X] [ ] [ ]

h. ever sought, received advice, counseling or
treatment for the use of alcohol, marijuana,
barbiturates, or drugs including
prescription drugs? [ ] [X] [ ] [ ]
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2. HAS ANY PROPOSED INSURED EVER BEEN DIAGNOSED
OR TREATED BY ANY MEMBER OF THE MEDICAL
PROFESSION FOR ACQUIRED IMMUNE DEFICIENCY
SYNDROME (AIDS)? [ ] [X] [ ] [ ]
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3. HAS ANY PROPOSED INSURED IN THE PAST 3 YEARS EVER HAD:

a. fainting spells, nervous disorder,
convulsions or paralysis? [ ] [X] [ ] [ ]
b. pain or discomfort in the chest, or
shortness of breath? [ ] [X] [ ] [ ]
c. disorder of the stomach, intestines,
rectum or blood in the urine? [ ] [X] [ ] [ ]
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4. HAS ANY PROPOSED INSURED EVER CONSULTED A PHYSICIAN FOR OR BEEN DIAGNOSED
OR TREATED FOR:

Proposed Insured
A B_D
Yes No Yes No

a. mental disorder, epilepsy or stroke?
b. disease or disorder of the heart or blood
vessels, heart attack, high blood
pressure, or rheumatic fever? [ ] [X] [ ] [ ]
c. elevated cholesterol? [ ] [X] [ ] [ ]
d. disease or disorder of the lungs, asthma,
emphysema, or tuberculosis? [ ] [X] [ ] [ ]
e. disease or disorder of stomach,
intestines, rectum, liver, or gall
bladder? [ ] [X] [ ] [ ]
f. disease or disorder of the kidney,
bladder, or prostate gland? [ ] [X] [ ] [ ]
g. sugar, albumin, blood, or pus in the
urine? [ ] [X] [ ] [ ]
h. cancer, tumor, syphilis, diabetes, gland
or blood disorder, ulcer, rupture, or
disease or disorder of the breast or
reproductive organs? [ ] [X] [ ] [ ]
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5. HAS ANY PROPOSED INSURED DURING THE PAST 3 YEARS:

a. received or claimed disability or
hospital indemnity benefits or a pension
for any injury, sickness, disability or
impaired condition? [ ] [X] [ ] [ ]

b. had any other impairment, sickness,
laboratory tests, or diagnostic
procedures? [ ] [X] [ ] [ ]

c. been confined in a hospital or other
health care facility, had a blood
transfusion, or had surgery performed,
advised, or contemplated? [ ] [X] [ ] [ ]
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6. Is any Proposed Insured now taking any
medication or under any treatment? [ ] [X] [ ] [ ]
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7. Medical Exam Certificate (Complete when submitting a medical examination
from another company.)

a. Attached examination is on the life of:

____________________________________________________

b. Name of insurance company for which examination was made and date of
the examination:

____________________________________________________
Company Date of Exam

c. Has Proposed Insured A or B consulted a
doctor or other practitioner or received
medical or surgical advice since the date
of the examination? [ ] [X] [ ] [ ]

d. To the best of Proposed Insured A's or
B's knowledge and belief, are any
statements in the examination now
inaccurate, as of today? [ ] [X] [ ] [ ]
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L 8754-95 REV 897 -2-

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8. FAMILY HISTORY

PROPOSED INSURED A

Family If living If not living, State of health or
History current age(s) age at death cause & date of death

Father

Mother

Brothers
& Sisters

PROPOSED INSURED B

Family If living If not living, State of health or
History current age(s) age at death cause & date of death

Father

Mother

Brothers
& Sisters

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9. PERSONAL PHYSICIAN INFORMATION

Proposed Insured A
Who is your personal physician?
Name: ____________________________________________________________
Address: _________________________________________________________
City ____________________________ State ___________ Zip___________
Phone: __________________________________________________________
Date personal physician was last seen? ___________________________
Reason Seen? _____________________________________________________

Proposed Insured B
Who is your personal physician?
Name: ____________________________________________________________
Address: _________________________________________________________
City ____________________________ State ___________ Zip___________
Phone: __________________________________________________________
Date personal physician was last seen? ___________________________
Reason Seen? _____________________________________________________

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EXPLANATIONS:

Details of any "Yes" answers to questions 1-7. Identify question number;
circle applicable items; include diagnosis, treatment dates, duration, and
names and addresses of all attending physicians and health care facilities.
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QUES (Proposed) Insured A QUES (Proposed) Insureds B_D

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PART 3. FINANCIAL INFORMATION

FINANCIAL INFORMATION MUST BE COMPLETED (1) FOR BUSINESS INSURANCE OR (2) FOR
A PROPOSED INSURED AGE 65 OR OVER OR (3) WHERE THE FACE AMOUNT EXCEEDS
$250,000 FOR PROPOSED INSUREDS UNDER AGE 65. IF FACE AMOUNT APPLIED FOR IS $1
MILLION OR MORE, PROVIDE AN EXPANDED FINANCIAL STATEMENT. I BELIEVE THAT THIS
PURCHASE OF LIFE INSURANCE IS SUITABLE FOR THIS APPLICANT/INSURED, BASED UPON
THE APPLICANT'S NEEDS, FINANCIAL SITUATION AND INSURANCE OBJECTIVES.
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1. FOR PERSONAL INSURANCE:
a. What is the purpose of the insurance? Check all that apply.
[ ] Estate preservation [ ] Family protection [ ] Mortgage protection
[ ] Charitable [ ] Other ____________________
b. What is the Proposed Insured(s)
1) Annual earned income $____________________
2) Annual interest & other income $____________________
(include retained earnings)
3) Total assets $____________________
4) Total liabilities $____________________
2. FOR BUSINESS INSURANCE:
a. What is the purpose of the insurance? Check all that apply.
[ ] Key person [ ] Buy-Sell [ ] Split dollar [ ] Stock redemption
[ ] Creditor [ ] Other
b. Annual net profit before taxes: Last year $____________________
2 years ago $____________________ net worth $____________________
c. If key person insurance: Retained earnings $ __________
Yes No
1) Are all partners or key people to be covered? [ ] [ ]
2) Does either Proposed Insured have an ownership
interest in the business? [ ] [ ]
If "Yes" what is Proposed Insured A's percent of ownership?__________%
If "Yes" what is Proposed Insured B's percent of ownership?__________%
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L 8754-95 REV 897 -3-

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SPECIAL INSTRUCTIONS

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AUTHORIZATION TO OBTAIN AND DISCLOSE INFORMATION

I hereby give my consent to: (1) any physician or medical practitioner; (2)
hospital, clinic, or other health care facility; (3) insurance or reinsurance
company; (4) consumer reporting agency, insurance support organization; (5)
my employer; or (6) the Medical Information Bureau, Inc., to give to American
General Life Insurance Company (American General Life) all information it has
pertaining to: (1) my medical consultations, treatments or surgeries; (2)
hospital confinements which concern the physical and mental condition of
myself, my spouse or my minor children; (3) my use of drugs or alcohol; or
(4) any other non-health (non-medical) information.

In turn, American General Life is free to disclose such information and any
information developed during its evaluation of my application to: (1) its
reinsurers; (2) the Medical Information Bureau, Inc.; (3) other insurance
companies; (4) me; (5) any physician designated by me; or (6) any person or
entity required to receive such information by law or as I may further
consent.

I, as well as any person authorized to act on my behalf, may, upon written
request, obtain a copy of this consent from American General Life.

This consent shall be valid for thirty (30) months from the date stated
below. I agree that a photocopy of this consent shall be as valid as the
original. I authorize American General Life to obtain an investigative
consumer report on me. I understand that I may: (1) request to be interviewed
in connection with the preparation of the investigative consumer report; and
(2) receive, upon written request, a copy of such report if no personal
interview is in fact conducted.

DECLARATION. I have read the above statements or they have been read to me. I
represent that the above statements are true and complete to the best of my
knowledge and belief. I understand that any misrepresentation contained in
this application and relied on by the Company may be used to reduce or deny a
claim or void the policy if it is within its contestable period and if such
misrepresentation materially affects the acceptance of the risk. Except as
may be provided in a Limited Temporary Life Insurance Agreement for which all
eligibility requirements are met, I understand and agree that no insurance
shall be in effect pursuant to this application, or under any policy issued
by the Company, until: (1) the policy has been delivered and accepted; (2)
the full first mode premium for the issued policy has been paid; and, (3)
between the date of the application and the delivery and acceptance of the
policy, there has been no material change in the health of any person
proposed for insurance. I understand and agree that no agent is authorized
to: (1) accept risks or pass upon insurability; (2) make or modify contracts;
or (3) waive any of the Company's rights or requirements.

I have received a copy of the Fair Credit Reporting Act, Medical Information
Bureau (MIB), Insurance Information Practices, and Telephone Interview
Information notices.

IF ELIGIBLE: I have received and accepted the Limited Temporary Life
Insurance Agreement. Temporary insurance is available only if: (1) the full
first mode premium is submitted with this application; and (2) only "No"
answers have been given in Part 1, Question 12.

Any person who includes any false or misleading information on an application
for insurance policy is subject to criminal and civil penalties.
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UNDER PENALTIES OF PERJURY, I CERTIFY: (1) THAT THE NUMBER SHOWN ON THIS
APPLICATION IS MY CORRECT SOCIAL SECURITY (OR 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 CONSENT TO ANY PROVISION OF THIS DOCUMENT OTHER THAN THE
CERTIFICATIONS REQUIRED TO AVOID BACKUP WITHHOLDING.
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Signed at ____________________ _____________________ Date: ______________
CITY STATE

_______________________________
SIGNATURE OF PROPOSED INSURED A
(If below age 15, signature of parent or guardian.)

_______________________________
SIGNATURE OF OWNER/TRUSTEE (If other than
Primary Proposed Insured. Show officer's title if signing for firm.)

_______________________________
SIGNATURE OF OWNER

_______________________________
SIGNATURE OF PROPOSED INSURED B

_______________________________
SIGNATURE OF OWNER

I certify that I have truthfully and accurately recorded on the application
the information supplied by the Proposed Insured(s) and personally witnessed
the signature(s) of the Proposed Insured(s).

_______________________________
AGENT NAME (Please Print)

_______________________________ __________ _________________
SIGNATURE OF AGENT AGENT NO. STATE LICENSE NO.
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L 8754-95 REV 897 -4-

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AGENT'S REPORT (MUST be completed to issue policy.)
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1. IF PRIMARY PROPOSED INSURED HAS LIVED AT PRESENT ADDRESS LESS THAN 5
YEARS, LIST PREVIOUS ADDRESSES FOR THE PAST 5 YEARS, WITH DATES.

List address where correspondence should be sent, if different than the
Primary Proposed Insured's or Owner's address shown in Part 1.

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2. CURRENT MARITAL STATUS

[ ] Married [ ] Single [ ] Divorced [ ] Separated [ ] Widowed
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3. IF MARRIED, WHAT AMOUNT OF INSURANCE IS IN FORCE
ON THE SPOUSE? $_________________
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4. IF PRIMARY PROPOSED INSURED IS A CHILD, WHAT AMOUNT OF INSURANCE IS IN
FORCE ON THE FATHER AND/OR MOTHER? $_________________
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5. HOW LONG HAVE YOU KNOWN THE PROPOSED INSURED(S)?
Insured A ______________ Insured B ______________
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6. ARE YOU RELATED BY BLOOD OR MARRIAGE TO ANY PROPOSED INSURED?
[ ] Yes [ ] No Relationship ______________
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7. DID YOU PERSONALLY SEE ALL PROPOSED INSUREDS AND ASK EACH AND EVERY
QUESTION AND ACCURATELY RECORD THEIR ANSWERS YOURSELF?
[ ] Yes [ ] No If "No" give details in Remarks.
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8. WHICH OF THE FOLLOWING HAVE YOU SCHEDULED?
Proposed Insured
A B
Blood Profile [ ] [ ]
HOS [ ] [ ]
Inspection [ ] [ ]
Resting EKG [ ] [ ]
Stress EKG [ ] [ ]
Chest X-Ray [ ] [ ]
Para Med ___________________________________________
NAME OF EXAMINER/SERVICE DATE
Medical ___________________________________________
NAME OF EXAMINER/SERVICE DATE
APS from ___________________________________________
DOCTOR DATE
APS from ___________________________________________
DOCTOR DATE
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9. COMPLETE IF PART 3 NOT COMPLETED
a. Purpose of insurance. Check all that apply.
[ ] Estate preservation [ ] Family protection [ ] Charitable
[ ] Mortgage protection [ ] Other _______________
b. Annual earned income of the Proposed Insured(s) or of the Payor, if
other than the Primary Proposed Insured
Proposed Insured A $________________
Proposed Insured B $________________
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10. TELEPHONE INTERVIEW INFORMATION

Best time to call Proposed Insured(s) at
Business (___)____________ Home (___)_______________
Time______________________ Time______________________
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11. AGENT(S) TO RECEIVE COMMISSION & VOLUME CREDIT

(Circle letter to indicate who Agency Agent Percent
should receive correspondence.) Number Number of credit

a.
b.
c.

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12. To the best of your knowledge, will the insurance applied for replace or
change existing insurance or annuity in this or any other company?
[ ] Yes [ ] No

(If "Yes", complete requirement of the state of residence.)
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REMARKS:

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_______ __________________________________ ___________________________
Date Contact Person if other than Agent SIGNATURE OF AGENT

__________________________________ ___________________________
Telephone No. of Agent PLEASE PRINT NAME

__________________________________ ___________________________
Facsimile No. of Agent STREET ADDRESS (Please Print)

___________________________
CITY STATE ZIP
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L 8754-95 REV 897 -5-

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BANK DRAFT INFORMATION
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The Automatic Bank Check plan, commonly known as ABC or Electronic Funds
Transfer, is a preauthorized debit service which offers a convenient way to
pay your insurance premiums. Under the ABC plan, your insurance premiums are
collected from your bank account electronically. After each premium payment
has been withdrawn from your bank account, a single-line entry in the amount
of your premium payment will appear on your bank statement. That entry will
be your receipt for payment of your premium. When paying with ABC, you no
longer have to write additional checks or mail any premium payments. As long
as you maintain a sufficient balance in your bank account, your insurance
premiums are automatically paid from your account with no further effort on
your part.

PREAUTHORIZED DEBIT AGREEMENT

I, the undersigned bank account owner, hereby authorize and request American
General Life Insurance Company ("Company") to initiate electronic or other
commercially accepted type debits against the indicated bank account in the
depository institution named below ("Depository") for the payment of premiums
and other indicated charges due on the insurance policy or policies listed
below (hereafter referred to as "Policy", whether one or more), and to
continue to initiate such debits in the event of a conversion, renewal or
other change to any such policy. I hereby agree to indemnify and hold the
Company harmless from any loss, claim or liability of any kind by reason or
dishonor of any debit.

I understand that this Authorization will not affect the terms of the Policy,
other than the mode of payment, and that if premiums are not paid within the
applicable grace period, the Policy will terminate, subject to any applicable
nonforfeiture provision. I acknowledge that the debit appearing on my bank
statement shall constitute my receipt of payment, but no payment is deemed
made until the company receives actual payment in its Home Office. I
understand that this Authorization will not result in any insurance becoming
effective under any conditional receipt or temporary insurance unless all
terms of such conditional receipt or temporary insurance have been met.

I agree that this Authorization may be terminated by me or the Company at any
time and for any reason by providing written notice of such termination to
the non-terminating party and may be terminated by the Company immediately if
any debt is not honored by the Depository named below for any reason.

Policy No. Insured Premium Amount

______________________ ______________________ ______________________

Bank Account Number ______________________ FREQUENCY: [ ] Monthly
Transit Routing Number____________________ [ ] Quarterly
Name of Depository _______________________ [ ] Semi-Annually
Address of Depository ____________________ [ ] Annually

Preferred withdrawal date _________________

[ ] Please initiate debits against my account for all outstanding premiums
due.

_______________________________ ________
Signature of Bank Account Owner Date

PLEASE ATTACH VOIDED CHECK

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L 8754-95 REV 897 -6-

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AMERICAN GENERAL LIFE INSURANCE COMPANY
Home Office: Houston, Texas
LIMITED TEMPORARY LIFE INSURANCE AGREEMENT

Received $_______________________ on this date from _______________________ .

This amount was paid when, on this date, a life insurance application was
signed in which is named as the Primary Proposed Insured. We agree to provide
temporary life insurance coverage as described below, subject to the rules
that follow:

ALL PREMIUM CHECKS MUST BE MADE PAYABLE TO THE COMPANY: DO NOT MAKE CHECK
PAYABLE TO THE AGENT OR LEAVE THE PAYEE BLANK.

NOTE: AGENT DOES NOT HAVE THE AUTHORITY TO ACCEPT A PREMIUM (INCLUDING
AUTOMATIC BANK DRAFT CHECK, SALARY SAVINGS OR GOVERNMENT ALLOTMENT) WITH THIS
APPLICATION IF THE CONDITIONS IN THE DECLARATION CANNOT BE MET; IF ANY PART
OF QUESTION 12 HAS BEEN ANSWERED "YES", ANSWERED FALSELY, OR LEFT BLANK, THIS
AGREEMENT WILL BE VOID AND ANY PAYMENT SUBMITTED WILL BE REFUNDED.

1. The full first mode premium must be submitted with this application. (Any
payment submitted must be honored on its first presentation for payment.)

2. The answer to all parts of question 12 must be "NO".

3. Upon receipt of due proof of the death of any person to be insured during
the period covered by this agreement, the total amount we will pay under
the policy, any riders, and this agreement, will be the lesser of:

(a) the amount applied for on such person; or
(b) $300,000 and the amount of any premium paid for coverage in excess of
$300,000 on such person.

4. Such payment will be made in one sum to the beneficiary stated in the
application. If death is due to suicide, payment will be limited to the
return of the amount paid. Coverage under this agreement will be subject
to the terms of the policy for which application is made.

5. Coverage will begin on the latest of the following dates:
(a) the date of the application;
(b) the date that all medical examinations have been taken; or
(c) the date requested in the application.

6. Coverage under this agreement will cease on the earliest of the following
dates:

(a) the date we issue the policy as applied for;
(b) the date a policy issued other than as applied for is offered to the
applicant;
(c) the date we decline the application;
(d) the date we state that the application will not be considered on a
prepaid basis; or
(e) 60 days from the date coverage begins under this agreement.

7. Any payment submitted to and accepted by the Company will be:

(a) applied to pay the first premium due if the policy is issued as
applied for;
(b) applied toward payment of the first premium if a policy is issued
other than as applied for and is accepted by the applicant;
(c) refunded if we decline the application or if the applicant refuses to
accept a policy issued other than as applied for.

No changes may be made in the terms and conditions of this form.

No statement which claims to make such a change will bind the Company.

I understand and agree that no agent is authorized to accept risks or pass
upon insurability, to make or modify contracts, or to waive any of the
company's rights or requirements.

Signed at ____________________ _____________________ Date: ______________
CITY STATE

_________________________ _____________________
SIGNATURE OF AGENT AGENT NUMBER
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L 8754-95 REV 897 -7-

DETACH THIS NOTICE & LEAVE IT WITH THE PROPOSED INSURED

AMERICAN GENERAL LIFE INSURANCE COMPANY

Home Office: Houston, Texas

NOTICE TO PROPOSED INSURED
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FAIR CREDIT REPORTING ACT

In compliance with the Fair Credit Reporting Act, as amended, we advise you
that we may, as a part of our normal procedure for processing your contract
application, request that an investigative consumer report be prepared
whereby information is obtained through personal interviews with your
neighbors, friends, former employers, primary insurance company or others
with whom you are acquainted. This inquiry includes information as to your
character, general reputation, personal characteristics and mode of living.

You have the right to make a written request to our home office within a
reasonable period of time to receive additional, detailed information about
the nature and scope of this investigation, if one is made. Please address
your request to New Business, American General Life Insurance Company, P.O.
Box 1931, Houston, Texas 77251-1931. These reports are obtained in your best
interest. They assist us in determining that the Company's insureds meet
certain standards, thus allowing us to continue offering coverage at the
lowest possible cost to all who qualify.

MEDICAL INFORMATION BUREAU

Information regarding your insurability will be treated as confidential.
American General Life Insurance Company or its reinsurers may, however, make
a brief report thereon to the Medical Information Bureau, a non-profit
membership organization of life insurance companies, which operates an
information exchange on behalf of its members. If you apply to another Bureau
member company for life or health insurance coverage, or a claim for benefits
is submitted to such a company, the Bureau, upon request, will supply such
company with the information in its file.

Upon receipt of a request from you, the Bureau will arrange disclosure of any
information it may have in your file. If you question the accuracy of
information in the Bureau's file, you may contact the Bureau and seek a
correction in accordance with the procedures set forth in the Federal Fair
Credit Reporting Act. The address of the Bureau's information office is Post
Office Box 105, Essex Station, Boston, Massachusetts 01112, telephone number
(617) 426-3660.

American General Life Insurance Company or its reinsurers may also release
information in its file to other life insurance companies to whom you may
apply for life or health insurance, or to whom a claim for benefits may be
submitted.

INSURANCE INFORMATION PRACTICES

To issue an insurance policy, we need to obtain information about you and any
other persons proposed for insurance. Some of that information will come from
you and some will come from other sources. That information and any
subsequent information collected by us may in certain circumstances be
disclosed to third parties without your specific authorization.

You have a right of access and correction with respect to the information
collected about you except information which relates to a claim or civil or
criminal proceeding.

If you wish to have a more detailed explanation of our information practices,
please contact: American General Life Insurance Company, New Business, P.O.
Box 1931, Houston, Texas 77251-1931.

TELEPHONE INTERVIEW INFORMATION (IF APPLICABLE)

To help us process your application as rapidly as possible, American General
Life may have one of its representatives contact you by telephone and at your
convenience to secure additional underwriting information.

You may be assured that all information developed in this interview will be
kept in strictest confidence and used solely for insurance purposes.
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