credit card payments for initial term premiums - AIG.com

Credit Card Payments for Initial Term Premiums
AIG Independent Agency Group is pleased to announce that effective March 1 st 2007,
we will accept credit card payment for initial premiums on term policies in all states
except New York and New Jersey. Please note, this applies only to initial premiums and
only to term policies, including LTG Ultra, LTG Ultra-C and ROPTerm. We will accept
payments via Mastercard, VISA and American Express, as well as debit cards.
Initial premiums can be paid via credit or debit card in conjunction with either the full life
application (#AGLC100565-2006), or the term-only application (#AGLC100240-2006).
In addition to the application and the other customary new business forms, you will need
to submit a credit card authorization form (#AGLC100949) for term cases where initial
premium will be paid via credit card. You can obtain state-specific versions of all new
business forms, including the credit card authorization, on FastForms Web, which is
accessible from our website (www.aig-iag.com).
For your reference, we have attached answers to frequently asked questions about
credit card premium payments, credit card processing guidelines, a sample declination
letter, and a credit card authorization form. We also attached a copy of the Limited
Temporary Life Insurance Agreement (LTLIA) and the LTLIA Receipt. The LTLIA
includes a completed and signed credit card authorization in its definition of how the
initial premium can be paid.
The ability to accept payment of initial term premiums via credit card represents an
important addition to our new business processing capabilities. Please review these
materials carefully and contact Producer Care Center 1-800-247-8837 prompt 1, prompt
2 with any questions.

Using Credit Card for Initial Premium – Frequent Asked Questions
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When can the applicant use a credit card to pay the initial premium?
A credit card may be used to pay initial premium for any term application,
including the Ultra, LTG Ultra-C and ROPTerm products.
Is credit card payment of initial term premiums allowed in all states?
No, it is allowed in all states except New Jersey and New York.
Which credit cards can be used?
Master Card, Visa and American Express may be used.
Can debit cards be used?
Yes, but please do not collect and submit the client’s debit card PIN
number.
What do I have to do to make this happen?
The applicant must complete the Credit Card Authorization Form in
duplicate, retain one copy and return the other with the application
paperwork. Some important items to check:
• The Credit Card Authorization must be completely filled out.
• The Card Number must be 16 digits and valid (15 digits for
American Express). Please make sure the card has not expired.
• The authorization must be signed by the cardholder.
When will the account be charged?
The account will be charged when the policy is put in force:
For applications that are issued as applied for, this will occur when issue
is processed. For applications that are conditionally issued, this will occur
when the delivery requirements are satisfied and the policy is put in force.
What happens if the credit card transaction is declined?
We will post a delivery requirement for the amount of initial premium
due on the case and send a letter to the client. The client can then either
write and submit a personal check for the full amount due or complete
another Credit Card Authorization.
If a client pays the initial term premium with a credit or debit card, will the
coverage be bound?
Please refer to the attached LTLIA for the answer to this question.
Can we also use a credit or debit card to pay on-going premium?
Not at this time. Only initial premiums may be paid via credit or debit
card.

Premium Processing
Initial Payment with a Credit Card
General Guidelines:
• The Credit Card Authorization Form must be filled out completely
□ The credit card number must be complete and legible on the form
□ For American Express the full 15 digits must be present
□ For MasterCard and Visa the full 16 digits must be present
• Credit cards are accepted for complete initial premium (amount required to put in
force) only. Partial premium payments will not be accepted
• Credit cards cannot be used for payment of permanent products
• Credit cards cannot be used for payment if the application state is New Jersey or
New York
• The acceptable credit card brands are American Express, MasterCard, Visa or
debit cards
• An ongoing payment mode must be provided on the Credit Card Authorization
Form
• The Credit Card Authorization form must be completed in duplicate – one copy
for the customer and one for American General Life Insurance Company
• The Credit Card Authorization form must be signed by the credit card holder
(whose name appears on the credit card)
• The credit card will not be charged until the case is put in force
• If the credit card is declined, has expired at the time of issue, or cannot be
accepted:
□ Amount of premium due will be based on mode noted on the application
□ The case will be Conditionally Issued and initial premium will be posted
as a delivery requirement
□ A status requirement stating ‘credit card declined’ will be posted
□ A credit card decline letter will be sent to the client

Sample
Generic Decline Letter
(Date)
{Owner Name}
{Addr 1}
{Addr 2}
{Addr 3}
{Zip}
Insured: {Insured Name}
Policy Number: {Policy #}
Dear {Owner Name}:
We have reviewed and completed processing of your application for insurance with
American General Life Insurance Company. At the time of application, you signed a
Credit Card Authorization and requested that your initial premium be paid via credit card.
However, we were not able to charge the initial premium to your credit card as requested.
Consequently, no coverage is in effect.
In order for coverage to take effect, we will need to collect the initial premium by check
at this time. Please send a check in the amount of {$###.##} to:
American General Life Insurance Company
Attn: IAG Room
750 W. Virginia St.
Milwaukee, WI 53204
Please write your policy number on the front of the check. If this check is not received
within thirty (30) business days of the date of this letter, this offer will terminate.
Should you have any questions, you may contact your agent.
Thank you for choosing American General Life Insurance Company. We look forward to
being able to complete this transaction and service all of your present and future
insurance needs.
Sincerely,
American General Life Insurance Company
Member of American International Group, Inc.
cc: {AGENT NAME}

Credit Card Authorization Form
American General Life Insurance Company
A member company of American International Group, Inc.
Form to be used only for the
collection of initial insurance premium
Please read this authorization carefully and complete all requested items.
Type of Insurance/Contract Applied For: ____________________________________________________________________
Policy Number: ____________________________________________________________________________________________
Name of Proposed Insured: ________________________________________________________________________________
Proposed Policy Owner:____________________________________________________________________________________
Cardholder Name: (exactly as it appears on the card) ________________________________________________________
Cardholder Billing Address: ________________________________________________________________________________
__________________________________________________________________________________________________________
Credit Card Number:_________________________________________________ Expiration Date: ______________________
Card Type: American Express ® MasterCard ® Visa ®
Quoted Initial Premium Amount: __________________ Mode of ongoing premium payments: ____________________
By signing below, I, _________________________________________________________, authorize American General Life
Insurance Company ("Company") or its representative to charge my credit card, listed above. I also understand and
agree that:
1) If there are no changes to the policy/contract as applied for or the frequency of ongoing premium payments,
the charge to my account for the Quoted Initial Premium Amount will be processed when the Company
places my policy/contract in force.
2) In the event of changes to the policy/contract as applied for or the mode of ongoing premium payments, the
new information will be communicated to me. If I accept the change(s), the charge to my account for the new
amount will be processed when the Company places my policy/contract in force.
I understand and agree that this transaction is subject to the acceptance by, and the terms and conditions of, the
credit card company indicated above. I understand and agree that this Authorization Form is not a part of the
application or policy/contract of insurance applied for and does not modify any terms or conditions contained
therein. I understand and agree that the Company shall incur no liability if the credit card company dishonors any
amount charged under this Authorization and may terminate this Authorization immediately if any charges are not
paid. I agree to hold the Company harmless against any liability pursuant to this authorization. I understand and
agree that payment of the initial premium is one of the conditions required for coverage to be placed into effect.
If the charge is declined for any reason, I understand and agree that coverage will not be placed into effect.
Cardholder’s Signature: X_____________________________________________________ Date: ______________________
For Internal Use Only
#: ________________________________________________ Date: _________________________________________________
AGLC100949 Please return this copy with the application. Rev0705

Credit Card Authorization Form
American General Life Insurance Company
A member company of American International Group, Inc.
Form to be used only for the
collection of initial insurance premium
Please read this authorization carefully and complete all requested items.
Type of Insurance/Contract Applied For: ____________________________________________________________________
Policy Number: ____________________________________________________________________________________________
Name of Proposed Insured: ________________________________________________________________________________
Proposed Policy Owner:____________________________________________________________________________________
Cardholder Name: (exactly as it appears on the card) ________________________________________________________
Cardholder Billing Address: ________________________________________________________________________________
__________________________________________________________________________________________________________
Credit Card Number:_________________________________________________ Expiration Date: ______________________
Card Type: American Express ® MasterCard ® Visa ®
Quoted Initial Premium Amount: __________________ Mode of ongoing premium payments: ____________________
By signing below, I, _________________________________________________________, authorize American General Life
Insurance Company ("Company") or its representative to charge my credit card, listed above. I also understand and
agree that:
1) If there are no changes to the policy/contract as applied for or the frequency of ongoing premium payments,
the charge to my account for the Quoted Initial Premium Amount will be processed when the Company
places my policy/contract in force.
2) In the event of changes to the policy/contract as applied for or the mode of ongoing premium payments, the
new information will be communicated to me. If I accept the change(s), the charge to my account for the new
amount will be processed when the Company places my policy/contract in force.
I understand and agree that this transaction is subject to the acceptance by, and the terms and conditions of, the
credit card company indicated above. I understand and agree that this Authorization Form is not a part of the
application or policy/contract of insurance applied for and does not modify any terms or conditions contained
therein. I understand and agree that the Company shall incur no liability if the credit card company dishonors any
amount charged under this Authorization and may terminate this Authorization immediately if any charges are not
paid. I agree to hold the Company harmless against any liability pursuant to this authorization. I understand and
agree that payment of the initial premium is one of the conditions required for coverage to be placed into effect.
If the charge is declined for any reason, I understand and agree that coverage will not be placed into effect.
Cardholder’s Signature: X_____________________________________________________ Date: ______________________
AGLC100949 Applicant: Please retain this copy for your records. Rev0705

This form must be completed, signed and left with the applicant.
Limited Temporary Life Insurance Agreement (Agreement)
THIS AGREEMENT PROVIDES A LIMITED AMOUNT OF LIFE INSURANCE COVERAGE FOR A LIMITED PERIOD
OF TIME, SUBJECT TO THE TERMS AND CONDITIONS SET FORTH BELOW. SUCH INSURANCE IS NOT
AVAILABLE FOR ANY RIDERS OR ACCIDENT AND/OR HEALTH INSURANCE. PLEASE FOLLOW STEPS 1 - 4.
1. Check appropriate Company:
American General Life The United States Life Insurance Company AIG Life Insurance
Insurance Company, in the City of New York, Company,
Houston, TX New York, NY Wilmington, DE
In this Agreement, "Company" refers to the insurance company whose name is checked above, which is
responsible for the obligation and payment of benefits under any policy that it may issue. No other company
shown is responsible for such obligations or payments. In this Agreement, "Policy" refers to the Policy or
Certificate applied for in the application. In this Agreement, “Proposed Insured(s)” refers to the
Primary Proposed Insured under the life policy and the Other Proposed Insured under a joint life or
survivorship policy, if applicable.
2. Complete the following: (please print)
Primary Proposed Insured ____________________________________________________________________________
Other Proposed Insured ______________________________________________________________________________
(applicable only for a joint life or survivorship policy)
Owner (if other than Primary Proposed Insured) ________________________________________________________
Modal Premium Amount Received ____________________________________________________________________
Date of Policy Application ____________________________________________________________________________
3. Answer the following questions:
a. Has any Proposed Insured ever had a heart attack, stroke, cancer, diabetes or disorder of the
immune system, or during the last two years been confined in a hospital or other health care
facility or been advised to have any diagnostic test or surgery not yet performed?
b. Is any Proposed Insured age 71 or above?
Yes
No
STOP If the correct answer to any question above is YES, or any question is answered falsely or left blank,
coverage is not available under this Agreement and it is void. This form should not be completed and
premium may not be collected. Any collection of premium will not activate coverage under this Agreement.
TERMS AND CONDITIONS OF COVERAGE UNDER THIS AGREEMENT
A. Eligibility for Coverage: If the correct answer is YES to any of the questions listed above, temporary insurance
is NOT available and this Agreement is void.
Agents do not have authority to waive these requirements or to collect premium by any means including
cash, check, bank draft authorization, credit card authorization, salary savings, government allotment, payroll
deduction or any other monetary instrument if any Proposed Insured is ineligible for coverage under this
Agreement.
B. When Coverage Will Begin:
COVERAGE WILL BEGIN WHEN ALL OF THE FOLLOWING CONDITIONS HAVE BEEN MET:
• Part A of the application must be completed, signed and dated; and
• The first modal premium must be paid; and
• Part B of the application must be completed, signed and dated and all medical exam requirements satisfied.
AGLC101431-2006 Page 1 of 2

Coverage under this Agreement will not exist until all of the conditions listed above have been met.
The first modal premium will be considered paid, if one of the following valid items is submitted with
Part A of the application and that payment is honored: (i) a check in the amount of the first modal premium;
(ii) a completed and signed Automatic Bank Draft Agreement; (iii) a completed and signed Credit Card
Authorization form; (iv) a completed and signed salary savings authorization; (v) a completed and signed
government allotment authorization; (vi) a completed and signed payroll deduction authorization. Temporary life
insurance under this Agreement will not begin if any form of payment submitted is not honored. All premium
payments must be made payable to the Company checked above. Do not leave payee blank or make payable to
the agent. The prepayment for this temporary insurance will be applied to the first premium due if the policy is
issued, or refunded if the Company declines the application or if the policy is not accepted by the Owner.
C. When Coverage Will End:
COVERAGE UNDER THIS AGREEMENT WILL END at 12:01 A.M. ON THE EARLIEST OF THE FOLLOWING DATES:
• The date the policy is delivered to the Owner or his/her agent and all amendments and delivery
requirements have been completed;
• The date the Company mails or otherwise provides notice to the Owner or his/her agent that it was unable
to approve the requested coverage at the premium amount quoted and a counter offer is made by the
Company;
• The date the Company mails or otherwise provides notice to the Owner or his/her agent that it has declined
or cancelled the application;
• The date the Company mails or otherwise provides notice to the Owner or his/her agent that the application
will not be considered on a prepaid basis;
• The date the Company mails or otherwise provides a premium refund to the Owner or his/her agent; or
• 60 calendar days from the date coverage begins under this Agreement.
D. The Company will pay the death benefit amount described below to the beneficiary named in the application if:
• The Company receives due proof of death that the Primary Proposed Insured (and the Other Proposed
Insured if the application was for a joint life or survivorship policy) died, while the coverage under this
Agreement was in effect, except due to suicide; and
• All eligibility requirements and conditions for coverage under this Agreement have been met.
The total death benefit amount pursuant to this Agreement and any other limited temporary life insurance
agreements covering the Primary Proposed Insured (and the Other Proposed Insured if the application was for
a joint life or survivorship policy) will be the lesser of:
• The Plan amount applied for to cover the Proposed Insured(s) under the base life policy; or
• $500,000 plus the amount of any premium paid for coverage in excess of $500,000; or
• If death is due to suicide, the amount of premium paid will be refunded, and no death benefit will be paid.
4. Complete and sign this section:
Any misrepresentation contained in this Agreement or the Receipt and relied on by the Company may be
used to deny a claim or to void this Agreement. The Company is not bound by any acts or statements that
attempt to alter or change the terms of this Agreement or the Receipt.
I, the Owner, have received and read this Agreement and the Receipt or they were read to me and agree to
be bound by the terms and conditions stated herein.
Signature of Owner __________________________________________________________
Signature of Primary Proposed Insured ________________________________________
Date ____________________
Date ____________________
Signature of Other Proposed Insured (if applicable) ____________________________ Date ____________________
Writing Agent Name (please print) ____________________________________________ Writing Agent # __________
AGLC101431-2006 Page 2 of 2

This form to be completed, detached and submitted with the signed application.
Limited Temporary Life Insurance Agreement Receipt
1. Check appropriate Company:
American General Life The United States Life Insurance Company AIG Life Insurance
Insurance Company, in the City of New York, Company,
Houston, TX New York, NY Wilmington, DE
In this Receipt, “Proposed Insured(s)” refers to the Primary Proposed Insured under the life policy and the
Other Proposed Insured under a joint life or survivorship policy, if applicable. The “Agreement” refers to
the Limited Temporary Life Insurance Agreement.
2. Complete the following: (please print)
Primary Proposed Insured ____________________________________________________________________________
Other Proposed Insured ______________________________________________________________________________
(applicable only for a joint life or survivorship policy)
Owner (if other than Primary Proposed Insured) ________________________________________________________
Modal Premium Amount Received ____________________________________________________________________
3. Answer the following questions:
a. Has any Proposed Insured ever had a heart attack, stroke, cancer, diabetes or disorder of the
immune system, or during the last two years been confined in a hospital or other health care
facility or been advised to have any diagnostic test or surgery not yet performed?
b. Is any Proposed Insured age 71 or above?
Yes
No
STOP If the correct answer to any question above is YES, or any question is answered falsely or left blank,
coverage is not available under the Agreement and it is void. This form should not be completed and
premium may not be collected. Any collection of premium will not activate coverage under the Agreement.
The Company will pay the death benefit amount described below to the beneficiary named in the application if:
• The Company receives due proof of death that the Primary Proposed Insured (and the Other Proposed
Insured if the application was for a joint life or survivorship policy) died, while the coverage under the
Agreement was in effect, except due to suicide; and
• All eligibility requirements and conditions for coverage under the Agreement have been met.
The total death benefit amount pursuant to the Agreement and any other limited temporary life insurance
agreements covering the Primary Proposed Insured (and the Other Proposed Insured if the application was for a
joint life or survivorship policy) will be the lesser of:
• The Plan amount applied for to cover the Proposed Insured(s) under the base life policy; or
• $500,000 plus the amount of any premium paid for coverage in excess of $500,000.
If death is due to suicide, the amount of premium paid will be refunded, and no death benefit will be paid.
4. Complete and sign this section:
Any misrepresentation contained in the Agreement or this Receipt and relied on by the Company may be
used to deny a claim or to void the Agreement. The Company is not bound by any acts or statements that
attempt to alter or change the terms of the Agreement or this Receipt.
I, the Owner, have received and read the Agreement and this Receipt or they were read to me and agree to
be bound by the terms and conditions stated therein.
Signature of Owner __________________________________________________________
Signature of Primary Proposed Insured ________________________________________
Date ____________________
Date ____________________
Signature of Other Proposed Insured (if applicable) ____________________________ Date ____________________
Writing Agent Name (please print) ____________________________________________ Writing Agent # __________
AGLC101432-2006