Fund Service Request Form - Penn Mutual Life

Instructions
Complete this form for Dollar Cost Averaging (DCA), Automatic Asset Rebalancing (AAR), One-Time Asset Rebalancing,
Fund Allocation Changes and Fund Transfer service requests on annuity products.
Important Information:
• Please note that you may not elect DCA and AAR simultaneously.
• DCA and AAR are not available for Optimizer Variable Annuities.
• Use form PM0258 if you wish to DCA your additional deposit from the 6 or 12 Month Fixed Account.
• Use form PS1023 if you wish to Dollar Cost Average on your Inflation Protector Benefit or Guaranteed Growth & Income
Benefit in the Withdrawal Phase.
Section 1 - Owner/Annuitant Information
Contract Owner Name (First, Middle, Last)
Fund Service Request Form
for Annuity Products
Contract Number
Annuitant Name (If different from Contract Owner)
Daytime Phone
( )
Section 2 - Dollar Cost Averaging (DCA) – Complete this section to add, change or terminate the Program.
DCA transfers will automatically occur on the 15th day of every month or the following business day. You must have a
minimum contract value of $10,000 and transfer a minimum of $100 monthly.
New Request Change in Current DCA Termination of DCA
I wish to transfer $____________________monthly ($100 minimum) over a_________month period (minimum of 12 months,
maximum of 60 months) from the following account (check one only):
PMAM Money Market PMAM Quality Bond PMAM Limited Maturity Bond
One Year Fixed Interest ( available for Pennant only)
Fixed Holding Account (available for Diversifier II only)
DCA will stop if the balance in the account you select above, falls below the minimum required. Any residual in this account
will automatically transfer to the allocation on record.
Transfer my money into the accounts below ($50 per account minimum):
Investment Managers Investment Options DCA $ Amount
AllianceBernstein
SMID Cap Value Fund
American Century
Mid Core Value Fund
Cohen & Steers Capital Management
Real Estate Securities Fund
Eaton Vance Management
Large Core Value Fund
Goldman Sachs Asset Management
Small Cap Value Fund
Ivy Funds
Mid Cap Growth Fund
Janus Capital Management
Small Cap Growth Fund
Loomis Sayles
Large Cap Value Fund
MFS Investment Management
Large Cap Growth Fund
Morgan Stanley Investment Mgmt.
Emerging Markets Equity Fund
Neuberger Berman Management
Penn Mutual Asset Management, Inc.
Penn Mutual Asset Management, Inc.
Penn Mutual Asset Management, Inc.
Penn Mutual Asset Management, Inc.
Penn Mutual Asset Management, Inc.
Penn Mutual Asset Management, Inc.
Penn Mutual Asset Management, Inc.
Penn Mutual Asset Management, Inc.
Penn Mutual Asset Management, Inc.
State Street Global Advisors
State Street Global Advisors
State Street Global Advisors
T. Rowe Price Associates
T. Rowe Price Associates
T. Rowe Price Associates
Vontobel Asset Management
Wells Capital Management
Wells Capital Management
Mid Cap Value Fund
Money Market Fund
Limited Maturity Bond Fund
Quality Bond Fund
Balanced Fund
Aggressive Allocation Fund
Moderately Aggressive Allocation Fund
Moderate Allocation Fund
Moderately Conservative Allocation Fund
Conservative Allocation Fund
Index 500 Fund
Small Cap Index Fund
Developed International Index Fund
Flexibly Managed Fund
Large Growth Stock Fund
High Yield Bond Fund
International Equity Fund
Large Core Growth Fund
SMID Cap Growth Fund
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Total $

Section 3 - Automatic Asset Rebalancing (AAR) – Complete this section to add, change or terminate the program.
You must have a minimum contract value of $10,000 to participate in the AAR program. AAR will occur at the end of each
calendar quarter (in March, June, September and December). AAR can only occur among the variable funds.
New Request Change in Current AAR Termination of AAR
I wish to rebalance the variable funds to reflect the following allocation at the end of each calendar quarter. Totals must
equal 100%. Use whole percentages only:
Investment Managers Investment Options AAR %
AllianceBernstein
SMID Cap Value Fund
American Century
Mid Core Value Fund
Cohen & Steers Capital Management
Real Estate Securities Fund
Eaton Vance Management
Large Core Value Fund
Goldman Sachs Asset Management
Small Cap Value Fund
Ivy Funds
Mid Cap Growth Fund
Janus Capital Management
Small Cap Growth Fund
Loomis Sayles
Large Cap Value Fund
MFS Investment Management
Large Cap Growth Fund
Morgan Stanley Investment Mgmt.
Emerging Markets Equity Fund
Neuberger Berman Management
Mid Cap Value Fund
Penn Mutual Asset Management, Inc.
Money Market Fund
Penn Mutual Asset Management, Inc.
Limited Maturity Bond Fund
Penn Mutual Asset Management, Inc.
Quality Bond Fund
Penn Mutual Asset Management, Inc.
Balanced Fund
Penn Mutual Asset Management, Inc.
Aggressive Allocation Fund
Penn Mutual Asset Management, Inc.
Moderately Aggressive Allocation Fund
Penn Mutual Asset Management, Inc.
Moderate Allocation Fund
Penn Mutual Asset Management, Inc.
Moderately Conservative Allocation Fund
Penn Mutual Asset Management, Inc.
Conservative Allocation Fund
State Street Global Advisors
Index 500 Fund
State Street Global Advisors
Small Cap Index Fund
State Street Global Advisors
Developed International Index Fund
T. Rowe Price Associates
Flexibly Managed Fund
T. Rowe Price Associates
Large Growth Stock Fund
T. Rowe Price Associates
High Yield Bond Fund
Vontobel Asset Management
International Equity Fund
Wells Capital Management
Large Core Growth Fund
Wells Capital Management
SMID Cap Growth Fund
Total $
Section 4 - One-time Asset Rebalancing, Future Allocation Changes & Fund Transfer Requests
One-time Asset Rebalancing (This will change current & future allocations)
I wish to rebalance the total assets of my annuity contract to the percentages shown under the Future Allocations
column.
Future Allocation Changes & Fund Transfer
I wish to make the following future allocation changes and/or fund transfers in my annuity contract.
Transfer Note: Please review the transfer provisions in your contract. To transfer existing funds or change the allocation of
your future payments, complete the sections below. The minimum transfer amount is $250.00. For partial transfers, the
amount remaining must be at least $250.00. Transfers may only be made from the Fixed Interest Options up to 25 days after
the expiration of the interest period. Option C funds transferred prior to the end of any thirty-six month period will be
reduced by a premature transaction penalty equal to 2 ½% of amount transferred. Fund options vary by product and are
subject to change at any time.
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Section 4 - One-time Asset Rebalancing, Future Allocation Changes & Fund Transfer Requests (continued)
Totals must equal 100% - Use whole percentages only
Investment Managers
Investment Options
Future
Investment Options
Allocations
From
To
AllianceBernstein
SMID Cap Value Fund % $ or % $ or %
American Century
Mid Core Value Fund
% $ or % $ or %
Cohen & Steers Capital Management Real Estate Securities Fund
% $ or % $ or %
Eaton Vance Management
Large Core Value Fund
% $ or % $ or %
Goldman Sachs Asset Management Small Cap Value Fund
% $ or % $ or %
Ivy Funds
Mid Cap Growth Fund
% $ or % $ or %
Janus Capital Management
Small Cap Growth Fund
% $ or % $ or %
Loomis Sayles Large Cap Value Fund 1
% $ or % $ or %
MFS Investment Management
Large Cap Growth Fund
% $ or % $ or %
Morgan Stanley Investment Mgmt. Emerging Markets Equity Fund
% $ or % $ or %
Neuberger Berman Management
Mid Cap Value Fund
% $ or % $ or %
Penn Mutual Asset Management, Inc. Money Market Fund 1
% $ or % $ or %
Penn Mutual Asset Management, Inc. Limited Maturity Bond Fund
% $ or % $ or %
Penn Mutual Asset Management, Inc. Quality Bond Fund 1
% $ or % $ or %
Penn Mutual Asset Management, Inc. Balanced Fund
% $ or % $ or %
Penn Mutual Asset Management, Inc. Aggressive Allocation Fund
% $ or % $ or %
Penn Mutual Asset Management, Inc. Moderately Aggressive Allocation Fund
% $ or % $ or %
Penn Mutual Asset Management, Inc. Moderate Allocation Fund
% $ or % $ or %
Penn Mutual Asset Management, Inc. Moderately Conservative Allocation Fund
% $ or % $ or %
Penn Mutual Asset Management, Inc. Conservative Allocation Fund
% $ or % $ or %
State Street Global Advisors
Index 500 Fund
% $ or % $ or %
State Street Global Advisors
Small Cap Index Fund
% $ or % $ or %
State Street Global Advisors
Developed International Index Fund
% $ or % $ or %
T. Rowe Price Associates
Flexibly Managed Fund 1
% $ or % $ or %
T. Rowe Price Associates
Large Growth Stock Fund 1
% $ or % $ or %
T. Rowe Price Associates
High Yield Bond Fund 1
% $ or % $ or %
Vontobel Asset Management
International Equity Fund 1
% $ or % $ or %
Wells Capital Management
Large Core Growth Fund
% $ or % $ or %
Wells Capital Management
SMID Cap Growth Fund
% $ or % $ or %
Fixed Interest Option
Fixed Holding Account 2
% $ or % $ or %
Fixed Interest Option
1 Year Fixed Interest 3
% $ or % $ or %
Fixed Interest Option
3 Year Fixed Interest 4
% $ or % $ or %
Fixed Interest Option
5 Year Fixed Interest 4
% $ or % $ or %
Fixed Interest Option
7 Year Fixed Interest 5
% $ or % $ or %
Fixed Interest Option
Interest Option B (One Month) 1
% $ or % $ or %
Fixed Interest Option
Interest Option A (One Year) 1
% $ or % $ or %
Fixed Interest Option
Interest Option C (Three Year) 1
% $ or % $ or %
Fixed Interest Option
6 Month Fixed Interest 6
% $ or % $ or %
Fixed Interest Option
12 Month Fixed Interest 6
% $ or % $ N/A or N/A %
Total Must Equal 100 %
% $ or % $ N/A or N/A %
1. Optimizer is limited to these funds only: Money Market Fund, Quality Bond Fund, Large Cap Value Fund, Flexibly Managed
Fund, Large Growth Stock Fund, High Yield Bond Fund, International Equity Fund, Interest Option B (One Month), Interest
Option A (One Year) and Interest Option C (Three Year).
2. The Fixed Holding Account is only available for Diversifier II annuity contracts.
3. One Year Fixed Interest Option is unavailable for contracts issued on or after 08/11/03, except for Diversifier II and
Retirement Planner Variable Annuity contracts.
4. Three and Five Year Fixed Interest Options are not available for Commander, Olympia XT, Enhanced Credit, Pennant
Select and Inflation Protector Variable Annuities. These options are also unavailable for Penn Freedom Variable Annuities
issued after 08/22/2011.
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Section 4 - One-time Asset Rebalancing, Future Allocation Changes & Fund Transfer Requests (continued)
5. The Seven Year Fixed Interest Option is not available for Commander, Olympia XT, Enhanced Credit, Pennant Select and
Inflation Protector Variable Annuities.
6. Six and Twelve Month Fixed Interest Options are available for Dollar Cost Average for the following products: Pennant
Select, Olympia XT, Enhanced Credit VA, PennFreedom, Smart Foundation VA and Inflation Protector VA contracts not in
the Withdrawal Phase. The Twelve Month Fixed Interest Options is not available for Retirement Planner VA.
Section 5 - Signatures
Contract Owner's Signature
/ /
Date (mm/dd/yyyy)
Joint Owner's Signature
/ /
Date (mm/dd/yyyy)
If Submitted by a Producer: By signing below, I signify that I have reviewed this transaction with the contract owner and
the contract owner is in agreement.
Producer's Signature
/ /
Date (mm/dd/yyyy)
Please return form to The Penn Mutual Life Insurance Company or The Penn Insurance & Annuity Company,
Mail Code C3R, P.O. Box 178, Philadelphia, PA 19105-0178.
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