Change of Ownership / Benefi ciary Request

RESET. American General Life Insurance Company Address mail to: Regular Mail Overnight Mail Annuity Service Center Box 15570 1050 North Western Street 800-445-7862. Amarillo, TX 79105-5570 Amarillo, TX 79106-7011 FAX: 818-615-1543. Change of Ownership / Beneficiary Request Note Changes of Ownership are subject to prior review and approval by American General Life Insurance Company (the Company ). Changing the Ownership or the beneficiary on your account might affect your living benefit or death benefit. Please see your prospectus for more details. Please print or type. I am using this form to Change Beneficiary Change Ownership AND Beneficiary (Complete sections 1, 4 and 5) (Complete sections 1, 2, 4 and 5). 1 Contract Information Contract (Certificate) Number _____ Current Owner's DOB _____. Current Owner's Last Name _____ First Name _____ MI _____. Address _____ City _____ State _____ Zip _____. Current Owner's SSN Phone # _____ Email _____. 2 New Owner's Information - Complete this section for a complete Ownership Change You must select one: Add a joint owner Replace current owner New Owner's Last Name First Name MI.

Change of Ownership / Benefi ciary Request Note • Changes of ownership are subject to prior review and approval by American General Life Insurance Company (the “Company”). • Changing the ownership or the benefi ciary on your account might affect your living benefi t or death benefi t. Please see your prospectus for more details.

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  Request, Benefi, Ciary, Benefi ciary request, Benefi ciary

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