American General Life Insurance Company The United States ...

American General Life Insurance Company The United States Life Insurance Company in the City of New York

Mailing Address: Annuity Service Center ? P.O. Box 871 ? Amarillo, TX 79105-0871 Overnight Mailing Address: Annuity Service Center ? 1050 N. Western Street ? Amarillo, TX 79106-7011

Corporate or Entity Resolution

Instructions: Use this form to purchase an annuity Contract issued by American General Life Insurance Company (AGL) / The United States Life Insurance Company in the City of New York (USL) when the owner is/will be a corporation, tax-exempt entity or state or other governmental entity or any instrumentality thereof. This form identifies those officers or individuals authorized by the Resolution in Section 3 to transact business on the Contract. If you are using this form to change an existing resolution, the information on this form replaces and takes priority over any prior resolution.

Annuities owned by entities that are not a natural person (as described under Internal Revenue Code Section 72(u)) generally do not qualify for tax deferral. AGL/USL does not file an annual IRS Form 1099 for contracts owned by corporations, tax-exempt entities, or governmental entities. The entity is responsible for determining its annual tax reporting obligation. You should consult with your tax advisor regarding the tax consequences of purchasing this annuity.

Please print of type.

1 Account Information

This form is being completed for an:

Application for annuity contract Existing annuity contract. List existing contract number(s) ____________________________________________________

2 Entity Information

Name of Entity ________________________________________________ Taxpayer ID Number __________________________ Street Address __________________________________ City _______________________ State _________ Zip _____________ Organized and Existing under laws of the State of ________________________________________________________________ Type of Entity (check one):

Corporation (provide proof of filing for Articles of Incorporation with state or county) Tax-exempt entity (provide copy of IRS Certificate of Determination) State or other government entity (provide proof of existence)

Corporate Owners Only: List all Individuals or Entities who have an ownership stake of 25% or more: Name ______________________________________________ Name ______________________________________________

Name ______________________________________________ Name ______________________________________________

3 Resolution

The following Resolution is hereby adopted by the

Board of _____________________________________________________________ on _________________________________

(e.g., Directors, Regents, Trustees, Governors)

(Meeting Date Resolution approved)

Resolved, each of the Designees listed in Section 4 herein is authorized to purchase an annuity contract issued by AGL/USL on behalf of the Entity.

Further Resolved, each of the Designees listed in Section 4 herein is authorized to execute on behalf of this entity any applications or agreements that may be required for the purchase and maintenance of the annuity contract.

Further Resolved, in the event of any change in the office or power of the Designees, the Officer/Authorized Party will immediately certify those changes to AGL/USL in writing.

Further Resolved, AGL/USL is hereby released from any liability and shall be indemnified against any loss, liability or expense arising from honoring these Resolutions.

AGL 2250 (9/16)

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Corporate or Entity Resolution

4 Designee(s) Authorized to Act on the Account

_____________________________________________________________________________________________________

Name and title (please print)

_________________________________________________ ______________________ _________, __________________

Signature

Date

_____________________________________________________________________________________________________

Name and title (please print)

_________________________________________________ ______________________ _________, __________________

Signature

Date

_____________________________________________________________________________________________________

Name and title (please print)

_________________________________________________ ______________________ _________, __________________

Signature

Date

5 Certification by Officer/Authorized Party:

I, the undersigned, hereby certify

I am an Officer or otherwise duly authorized individual who can sign this form on behalf of the Entity listed in Section 2.

The Entity listed in Section 2 is duly organized and validly existing under the laws of the State listed in Section 2.

The Resolution in Section 3 (i) was duly adopted by the Board at its official meeting as listed in Section 3; (ii) has been recorded by the Entity in accordance with its standard practices; (iii) is in accordance with and does not conflict with the existing articles of incorporation/organization, by-laws or other governing documents for the Entity; (iv) has not been modified or rescinded and (v) is still in full force and effect.

The persons listed in Section 4 are Entity officers authorized to transact business on the annuity contract issued by AGL/USL and the signatures herein are authentic, official signatures of said persons. If more than one Entity officer:

Any Entity officer is able to act independently All Entity officers must act jointly Other (please specify) ________________________________________________________________

________________________________________________________________________

Name (please print)

________________________________________________________________________

Title (please print)

________________________________________ _____________ _______, _________

Signature

Date

AGL 2250 (9/16)

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