EXHIBIT 5(c)(iv)(C)
AMERICAN GENERAL LIFE INSURANCE COMPANY ("AGL")
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A Subsidiary of American General Corporation
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Houston, Texas
COMPLETE AND RETURN TO: WM Strategic
Annuity Administration Asset Manager
P.O. Box 1401
Houston, TX 77251-1401
(000) 000-0000
Hearing Impaired: (000) 000-0000
--DOLLAR COST AVERAGING ENROLLMENT FORM--
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SECTION I: ENROLLMENT | TO INITIATE A SPECIAL DOLLAR COST AVERAGING PLAN:
| FOR NEW CONTRACTS:
Please transfer entire amount allocated to the 1-Year |
Guarantee Period in equal monthly amounts over the period | . Select your initial allocations in Section 6 of the
indicated below: | WM Strategic Asset Manager Variable Annuity Application
| (L8908), allocating the desired percentage to the 1-Year
[ ] 6 MONTHS - 6-Month Dollar Cost Avg (DCA) OR | Guarantee Period.
[ ] 12 MONTHS - 12-Month Dollar Cost Avg (DCA) |
| (Minimum allocation to the 1-Year Guarantee Period is $5,000)
Balances in the 1-Year Guarantee Period that are subject to |
the Special Dollar Cost Averaging Plan, pursuant to this | . In lieu of Section 7 of the Application, complete this
service form, will earn interest at the rate of __%, which | service form to begin a Special Dollar Cost Averaging Plan
represents an increase of __% over the 1-Year Guarantee | from the 1-Year Guarantee Period.
Period interest rate offered. |
-------------------------------------------------------------- | . Submit this service form with your Application.
SECTION II: INVESTMENT ALLOCATIONS |
| FOR EXISTING CONTRACTS--CONTRACT # VA______________________:
Please apply the monthly transfer to the Division(s) as |
indicated below: | . Complete this service form and submit it with an additional
(Use only whole percentages. Total allocation must equal 100%.)| purchase payment.
WM VARIABLE TRUST - The available variable divisions are |
funded by the following Series. | . The entire additional payment will be applied toward the
| 1-Year Guarantee Period and transferred into the specified
Strategic Growth Portfolio (60) _________________% | Division(s) as indicated in Section II.
Conservative Growth Portfolio (61) _________________% |
Balanced Portfolio (62) _________________% | . Additional payments may not be invested into the Special
Flexible Income Portfolio (63) _________________% | Dollar Cost Averaging Plan while an existing Special Dollar
Income Portfolio (64) _________________% | Cost Averaging Plan or any other dollar cost averaging
Bond & Stock Fund (66) _________________% | plan is active.
Growth & Income Fund (71) _________________% |
Growth Fund of the Northwest (67) _________________% |
Growth Fund (72) _________________% |
Mid Cap Stock Fund (75) _________________% |
Small Cap Stock Fund (73) _________________% |
International Growth Fund (74) _________________% |
Short Term Income Fund (68) _________________% |
U.S. Government Securities Fund (69) _________________% |
Income Fund (70) _________________% |
Money Market Fund (65) _________________% |
Other______________________ _________________% |
|
NOTE: ALL MONEY ALLOCATED WILL BE TRANSFERRED IN EQUAL |
MONTHLY AMOUNTS OVER A 6-MONTH OR 12-MONTH PERIOD, BEGINNING |
30 DAYS AFTER THE REQUEST DATE. THE FINAL AMOUNT TRANSFERRED |
WILL INCLUDE ALL OF THE REMAINING BALANCE. |
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SECTION III: SIGNATURES
Your signature below indicates you have received a WM Strategic Asset Manager prospectus and authorizes your request to begin the
Special Dollar Cost Averaging Plan. All transactions will be confirmed. Please review the information on your confirmation
statements carefully. All errors or corrections must be reported to American General Life Insurance Company ("AGL") immediately
to assure proper crediting. AGL will assume all transactions are accurate unless notified within 30 days.
You may elect to terminate your Special Dollar Cost Averaging Plan by calling or writing AGL. The termination will become effective
prior to the next transfer following such notification. Upon termination, you will no longer receive the increased interest rate.
AGL may delay processing any additional transfer or liquidation request if received on the date of a scheduled Special Dollar Cost
Averaging Plan transfer. In addition, AGL reserves the right to discontinue, modify, or amend this offer at any time. Any changes
made to this offer will not affect Contract Owners currently participating in a Special Dollar Cost Averaging Plan.
_______________________________________________________________ _______________________________________________________________
SIGNATURE OF OWNER SOCIAL SECURITY NUMBER OF OWNER
_______________________________________________________________ _______________________________________________________________
PRINT OWNER NAME SIGNATURE OF JOINT OWNER (IF APPLICABLE)
_______________________________________________________________ _______________________________________________________________
PHONE DATE PRINT LICENSED AGENT NAME
___________________________________________________________________________________________________________________________________
L 8966-1SAM 0400
