Exhibit (e)(7)
AMERICAN GENERAL
Life Companies
EXECUTIVE ADVANTAGE/SM/
REALLOCATION and REBALANCING REQUEST
Insured: _________________________________ Policyholder: ___________________________________________
(Last Name, First Name, Middle Name) (Last Name, First Name, Middle Name)
Policy Number: ____________________ Social Security No.: ____-____-______
. Restrictions on Subaccount Transfers are shown in the Certificate and
Certificate Information pages.
. The Policyholder may make 12 free transfers during a Certificate Year. A
$25 transfer charge may be imposed on each subsequent transfer.
. Transfers from the Guaranteed Account may be made to a Subaccount(s)
only during the 60 day period that is 30 days before and 30 days after
the end of each Certificate Anniversary.
. Transfers must be in whole dollars or whole percentages.
Please rebalance the subaccounts to achieve the percentages indicated
below. I understand that the subaccounts will only achieve these
percentages on the date the transfers occur. Future charges and
investment results will cause the balances to change. This form will
also change future premium payments to be allocated as indicated below,
until changed by the Owner.
Percent
GUARANTEED ACCOUNT _______% -------
AIM VARIABLE INSURANCE FUNDS (INVESCO VARIABLE INSURANCE
FUNDS) XXXXXXX XXXXX VARIABLE INSURANCE TRUST
Invesco Xxx Xxxxxx V.I. High Yield Fund _______% Strategic International Equity Fund _______%
Invesco Xxx Xxxxxx V.I. American Value Fund _______% Structured U.S. Equity Fund _______%
ALLIANCE XXXXXXXXX VARIABLE PRODUCTS SERIES FUND, INC. JPMORGAN INSURANCE TRUST
Growth Portfolio _______% Small Cap Core Portfolio _______%
Growth and Income Portfolio _______% THE UNIVERSAL INSTITUTIONAL FUNDS, INC.
Large Cap Growth Portfolio _______% Core Plus Fixed Income Portfolio _______%
Small Cap Growth Portfolio _______% Emerging Markets Equity Portfolio _______%
AMERICAN CENTURY VARIABLE PORTFOLIOS, INC. Mid Cap Growth Portfolio _______%
VP Income & Growth Fund _______% XXXXXXXXX XXXXXX ADVISERS MANAGEMENT TRUST
VP International Fund _______% AMT Large Cap Value Portfolio _______%
BLACKROCK VARIABLE SERIES FUNDS, INC. PIMCO VARIABLE INSURANCE TRUST
BlackRock Basic Value V.I. Fund _______% High Yield Portfolio _______%
BlackRock Capital Appreciation V.I. Fund _______% Long-Term U.S. Government Portfolio _______%
BlackRock U.S. Government Bond V.I. Fund _______% Real Return Portfolio _______%
BlackRock Value Opportunities V.I. Fund _______% Short-Term Portfolio _______%
FIDELITY VARIABLE INSURANCE PRODUCTS Total Return Portfolio _______%
VIP Balanced Portfolio _______% VANGUARD VARIABLE INSURANCE FUND
VIP Contrafund Portfolio _______% Total Bond Market Index Portfolio _______%
VIP Index 500 Portfolio _______% Total Stock Market Index Portfolio _______%
VIP Money Market Portfolio _______% VALIC COMPANY I
FRANKLIN XXXXXXXXX VARIABLE INSURANCE PRODUCTS TRUST International Equities Fund _______%
Developing Markets Securities Fund - Class 2 _______% Mid Cap Index Fund _______%
Foreign Securities Fund - Class 2 _______% Small Cap Index Fund _______%
Growth Securities Fund - Class 2 _______%
--------------------------------------------- ----------------------------------------------------------
Signature of Insured Signature of Policyholder (if other than Insured)
__________________________ ______, 20______
Date Signed
Rebalance, Executive Advantage/SM/, 09/12
