0001193125-13-186239 Sample Contracts

Insured: Policyholder: (Last Name, First Name, Middle Name) (Last Name, First Name, Middle Name) Policy Number: Social Security No.: - -
Reallocation and Rebalancing Request • April 30th, 2013 • Separate Account II of AGL

. 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.

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