Schwab OneSource ChoiceTM Variable Annuity Investment Choice Fax Transfer Request Form
To: RROC From (Authorized Trader): ______Phone #: 888-667-2145, Opt 1 Master Account #: ______Fax #: 866-442-3887 Phone Number: ______Number of Pages: ______Date: ______
Authorized Signature (Authorized Trader): ______
Social Security # Contract Owner From Fund To Fund $ or %
• Faxes received by 4:00 PM EST (NYSE close) generally will be executed at that day’s valuation. • Transfer requests received after NYSE close will be executed at the next day’s valuation • If we do not confirm receipt of your fax within 30 minutes of its transmission, please call us to confirm. • Transfers will not affect the allocations of future contributions. Transfer requests for contracts within the right of cancellation period and where the assets are restricted to the Schwab Government Money Market sub-account, will not be executed. Please call us to make any changes to allocation of future contributions or to make any changes during the right of cancellation period. • All transactions are subject to the terms and conditions described in the contract and prospectus for the Schwab OneSource Choice™ Variable Annuity. • To accomplish block trading, please indicate the allocations on page one and list your clients’ policy information on page 3.
Page 1 of 4 Revised 08/2018 Schwab OneSource ChoiceTM Variable Annuity Investment Choice Fax Transfer Request Form
Bond Mid-Cap Federated Fund for US Government Securities II FUS AB VPS Small/Mid Cap Value A ABS Great-West Multi-Sector Bond Inv GLS American Century Investments® VP Mid Cap Value II AMV Invesco VI High Yield I IHY ClearBridge Variable Mid Cap I CBM Janus Henderson Flexible Bond Svc JFS Delaware VIP® Smid Cap Core Series Std DGO PIMCO VIT Emerging Markets Bond Admin PEB Dreyfus IP MidCap Stock Init DMS PIMCO VIT High Yield Admin PHY DWS Small Mid Cap Growth VIP A SSC PIMCO VIT Low Duration Admin PLD Great-West Mid Cap Value Inv GGM PIMCO VIT Real Return Admin PRR Great-West T. Rowe Price Mid Cap Growth Inv TPM PIMCO VIT Total Return Admin PVR LVIP Baron Growth Opportunities Svc BRC Pioneer Bond VCT I PBO MFS® VIT III Mid Cap Value Init MMV Putnam VT Mortgage Securities IB PAG Neuberger Berman AMT M/C Intrinsic Value S NBR Putnam VT Income IA PIC Pioneer Select Mid Cap Growth VCT I SFG Templeton Global Bond VIP 2 TPG Wells Fargo VT Discovery 2 SMC Wells Fargo VT Opportunity 2 SOF Index Funds DWS Small Cap Index VIP A BTS Large Cap Great-West Bond Index Inv GWB AB VPS Growth A AGP NVIT Mid Cap Index II DMI AB VPS Growth and Income A AGI Schwab® S&P 500 Index Portfolio SSP Alger Capital Appreciation I-2 ACA American Century VP Income & Growth I ACG Specialty American Century VP Value I ACV AB VPS Real Estate Investments A ARE American Funds IS® Growth-Income 4 AFG Columbia VP Seligman Global Technology 2 SGT ClearBridge Variable Large Cap Growth I CBL Goldman Sachs VIT Multi-Strat Alternatives Svc GMS Columbia VP Large Cap Growth 2 CLC Janus Henderson Global Technology Svc JGT Delaware VIP® Value Series Std DVS MFS® VIT Utilities Series Svc MVU Dreyfus VIF Growth & Income Init DRG PIMCO VIT CommodityRealReturn Strategy Admin PCD DWS Capital Growth VIP A SCC T. Rowe Price Health Sciences Port II THS DWS Core Equity VIP A SCS VanEck VIP Global Hard Assets S VIH Invesco VI Comstock I VKC Invesco VI Growth and Income I VKG Small-Cap Pioneer Fund VCT I STE ClearBridge Variable Small Cap Growth I CBS Putnam VT Equity Income IB PTE Columbia VP Small Cap Value 2 CCV Putnam VT Multi-Cap Core IA PUI Delaware VIP® Small Cap Value Series Std DLS Touchstone Focused Fund TVM Franklin Small Cap Value VIP 2 FSV Wells Fargo VT Omega Growth 2 WOG Great-West Invesco Small Cap Value Inv GIS Invesco VI Small Cap Equity I ASE JPMorgan Insurance Trust Small Cap Core 1 MSC Money Market Oppenheimer Main Street Small Cap VA® Non-Svc OMS Schwab Government Money Market Portfolio™ SMM Putnam Small Cap Value IA PTS Touchstone Small Company Fund SVS
Page 2 of 4 Revised 08/2018 Schwab OneSource ChoiceTM Variable Annuity Investment Choice Fax Transfer Request Form
International Asset Allocation/Other ALPS/Red Rocks Listed Private Equity I ARR American Century Investments® VP Balanced I ACB ® American Century Investments VP International I ACI BlackRock Global Allocation V.I. Fund I BGA ® American Funds IS New World 2 AFN Great-West Aggressive Profile Fund Inv GWA ® Delaware VIP Emerging Markets Series Std DEG Great-West Conservative Profile Fund Inv GCP ® Delaware VIP International Value Equity Series Std DVI Great-West Lifetime 2015 Inv G15 DWS Global Small Cap VIP A DGC Great-West Lifetime 2020 Inv G20 Invesco VI International Growth I AIG Great-West Lifetime 2025 Inv G25 Ivy VIP International Core Equity II IIC Great-West Lifetime 2030 Inv G30 Janus Henderson Global Research Instl JGR Great-West Lifetime 2035 Inv G35 Lazard Retirement Emerging Markets Equity Svc LRE Great-West Lifetime 2040 Inv G40 ® MFS VIT II International Value Svc MVI Great-West Lifetime 2045 Inv G45 Oppenheimer Global VA Non-Svc OGS Great-West Lifetime 2050 Inv G50 Oppenheimer International Growth VA Non-Svc OIG Great-West Lifetime 2055 Inv G55 Putnam VT International Equity IA PIE Great-West Moderate Profile Fund Inv GMP Putnam VT International Value IA PIV Great-West Moderately Aggressive Profile Fund Inv GMA Great-West Moderately Conservative Profile Fund Inv GMC Janus Henderson Balanced Svc JBS Putnam VT Global Asset Allocation IA PGL
The following sub-accounts are Closed to New Investments Alger Large Cap Growth I-2 AAG Alger Mid Cap Growth I-2 AMG DWS CROCI® U.S. VIP A SLC DWS Small Mid Cap Value VIP A DSV Dreyfus VIF Appreciation Init DRC Invesco VI Mid Cap Core Equity I AME Invesco VI Technology Fund I ITF Pioneer Mid Cap Value VCT II PMC Putnam VT Global Health Care Fund IB PHC VanEck VIP Unconstrained Emerging Mkts Bond Init VIB Templeton Foreign VIP Fund 2 TFS Touchstone Common Stock Fund SVC Touchstone Bond Fund SVB
Page 3 of 4 Revised 08/2018 Schwab OneSource ChoiceTM Variable Annuity Investment Choice Fax Transfer Request Form
To: RROC From (Authorized Trader): ______Phone #: 888-667-2145, Opt 1 Master Account #: ______Fax #: 866-442-3887 Phone Number: ______Number of Pages: ______Date: ______
Authorized Signature (Authorized Trader): ______
BLOCK TRADING INFORMATION To accomplish block trading, please list the allocations on page 1 and list your client information below.
Policy Number Client SSN Client Name
Page 4 of 4 Revised 08/2018