American General Life Individual Registered Index-Linked Annuity Application (ICC24-AGA-228)

[Product Name]

(Enter two-character state code)      

Joint Owners (Joint Annuitants, if Contract is [non-naturally owned]) shall be each other’s sole primary beneficiary and any other beneficiary listed will be designated as “contingent.”

•   If one Owner is listed on Page 1 and the beneficiary type is not selected below, the beneficiary will be designated as “primary.”

•   Multiple beneficiaries will share the death benefit equally, unless otherwise specified, and percentages must total 100%.

•   For [non-naturally owned] Contracts, if no beneficiary is listed below, the beneficiary will default to the Owner listed on this Application.

•   If the Owner is a trust, the trust must be designated as the sole primary beneficiary.

☐   Check this box if providing additional beneficiaries on the [Additional Beneficiary Information] form or a separate sheet signed by the Owner.

Death Benefit Election: A selection must be made below for this Application to be in good order.

☐ Contract Value Death Benefit

☐ Optional Return of Purchase Payment (ROP) (A fee is associated with this election, please review your prospectus for additional information.)]

[7(a).] Investment Options

Your Purchase Payment will be allocated based on Your investment choices indicated on the required [Allocation Account Election and Transfer Authorization Form].

IMPORTANT: Your [Allocation Account Election and Transaction Authorization Form] must be included with this Application to ensure that your Application is processed immediately.

*Email address:                                           

*  Custodially owned Contracts: Provide the Annuitant’s email address. Other [non-natural] Owners (such as trusts): Provide the email address of the authorizing signatory.]

In some states we are required to advise you of the following: Any person who knowingly presents a false statement in an Application for insurance may be guilty of a criminal offense and subject to penalties under state law.

[USA PATRIOT ACT (This notice is printed in compliance with Section 326 of the USA Patriot Act) IMPORTANT INFORMATION ABOUT PROCEDURES FOR APPLYING FOR AN INSURANCE POLICY OR ANNUITY CONTRACT

To help the government fight the funding of terrorism and money laundering activities, federal law requires all financial institutions, including insurance companies, to obtain, verify, and record information that identifies each person who opens an account, including an Application for an insurance policy or annuity Contract. What this means for you: When you apply for an insurance policy or annuity Contract, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver’s license or other identifying documents.]

 [9(b).] Acknowledgements of Owner(s)

I represent that all statements and information provided herein are true and complete to the best of my belief and knowledge. I understand that the Application will be attached to and made a part of the annuity Contract. By signing below, I declare the following:[

•   I have received, read, and understand the Buyer’s Guide for Deferred Annuities.]

•   I acknowledge receipt, either physically or electronically, of the current prospectus, which includes the applicable allocation account options, for this [registered index-linked annuity].

•   After consulting with my [Financial Professional] and reviewing the prospectus, I confirm that this [registered index-linked annuity] [and, the Death Benefit Election I selected, which may include additional fees,] is suitable for my objectives and needs. I understand that [the company] issues other annuities with similar benefits and limitations, which may have lower charges. I have discussed the alternatives with my [Financial Professional].

•   I have consulted with my [Financial Professional] for advice or recommendations regarding the purchase of this [registered index-linked annuity] Contract. American General Life Insurance Company is not providing advice, guidance or recommendations and is not serving in any fiduciary capacity related to this Contract.

•   I acknowledge that I have read the current prospectus for this [registered index-linked annuity] carefully and understand their contents.

•   I understand that American General Life Insurance Company will not credit or pay interest earnings, if any, on my purchase payments until all expected purchase payments are received and the Contract has been issued.

•   I UNDERSTAND THAT THE VALUE OF AMOUNTS ALLOCATED TO A SEPARATE ACCOUNT DURING THE ACCUMULATION PERIOD IS NOT GUARANTEED AND WILL INCREASE OR DECREASE BASED UPON THE INVESTMENT EXPERIENCE OF THE STRATEGY ACCOUNT OPTION(S) THAT I CHOSE. THERE IS A RISK OF LOSS AND LOSS MAY BE GREATER IF WITHDRAWAL, DEATH, BEGINNING AN INCOME PLAN, OR A TOTAL WITHDRAWAL OCCURS BEFORE THE TERM END DATE. THE GAINS MAY BE LIMITED AND ARE NOT GUARANTEED. WHILE INTEREST CREDITED TO THE STRATEGY ACCOUNT OPTION(S) IS BASED IN PART UPON THE CHANGE IN AN EXTERNAL INDEX OR INDICES, THE CONTRACT DOES NOT DIRECTLY PARTICIPATE IN ANY STOCK, BOND OR INDEX INVESTMENT. THE INTERIM VALUE MAY REFLECT A NEGATIVE RETURN EVEN IF THERE IS AN INCREASE IN THE INDEX OR INDICES, MAY REFLECT A POSITIVE RETURN EVEN IF THERE IS A DECREASE IN THE INDEX OR INDICES, AND MAY BE LOWER THAN THE AMOUNT AVAILABLE ON THE TERM END DATE.

•   If I am funding a tax-qualified retirement plan with this annuity, I understand that (1) there may be more robust insurance benefits offered in other annuities and (2) the annuity does not provide any additional tax deferral treatment beyond that which I already have under my plan.

•   My investment choices were included on the [Allocation Account Election and Transfer Authorization Form], my signature below indicates that I am providing the [Allocation Account Election and Transfer Authorization Form] with this Application.

•   My answers are representations and not warranties, and are true and correct to the best of my knowledge and belief.