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Get AIG VL 20568 2008-2024

Control P.O. Box 15648, Amarillo, TX 79105-5648 Call 1-800-448-2542 for assistance. 1. Client Information Name:__________________________________________________________________ SSN or Tax ID: ______________________________________ Daytime Phone: (________)__________________________ Date of Birth: ______________________ Group Name/Number:__________________________ 2. ROLLOVER/TRANSFER OUT REQUEST Indicate if you are requesting a Rollover or Transfer by checking one of the boxes .

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