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EXHIBIT 7
FORM OF APPLICATION FOR FUND B CONTRACTS
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Request For Participation Under Group Annuity Contract AUL(R)
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American United Life Insurance Company(R)
Type or Print
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Participants Name Male
Last First Middle Female
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Beneficiary's Name Relationship to Participant
Last First Middle
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Secondary Beneficiary (if any) Participant's Date of Birth
Mo. Day Year
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Participants Address (show zip code) Participant's Social Security Number
-- --
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Contractholders Name and Address Contract Number Plan (check one)
Group Number TDA __ XXX __ SEP__ DCP __
Plan I __ Plan I __ Plan I __
Plan II __ Plan II __ Plan II __
Plan III __ Plan III __ Plan III __
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Servicing Agent's Name and Number First Year's Contributions
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,19
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Date of Application Signature of Participant
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Name and Residence Address (show zip code) Occupation Date of Employment
-- --
Mo. Day Year
Payments For Participant
Employee Contributions Employer Contributions
Total Payment per pay period _________________ ____________________
Pay periods per contract year _________________ ____________________
Pay period of first payment _________________ ____________________
0% 25% 50% 75% 100% other __________%* of payment to be allocated to an equity
fund to provide Variable Benefits (to fluctuate with investment experience),
balance to provide Fixed-dollar Benefits.
* Percentage remains in effect until written notice of change received by AUL at
its Home Office.
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___________________,19__ ________________________________
Date Signed Signature of Participant
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Servicing Agents Name and Number Approval By Principal of Broker Dealer
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(Complete if enrolling in Variable Annuity)
SUITABILITY QUESTIONNAIRE
Agents selling variable annuities are required to make the following inquiries
relating to the financial condition and other retirement plans of participants
under variable annuity contracts. Participants arc urged to supply such
information but they are not required to do so. Those who do not wish to do so
should check Item 9 and sign below.
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1. Family members or dependents:
Name Relation Age Name Relation Age
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2. Annual earned income from employer 3. Other income (describe)
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4. Value of assets: Home Car Stocks Savings
Checking Other (describe)
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5. Amount of Life Insurance 6. Covered under Federal Social Security
__ Yes __ No
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7. Other retirement resources (include annuities--state whether variable or
fixed)
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8. Value of Liabilities (describe)
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9. __ I understand the agent is required to make the above inquiries to enable
him to form an opinion as to the suitability of the variable annuity for my
retirement program. However, I do not wish to divulge this information.
I certify that I have received a prospectus.
___________________________________________ __________________________________
Signature of Participant Licensed Registered Representative
P-8088M
