EX-4 9 exhibit26e2.htm EXHIBIT 26(E)(2): FUND ALLOCATION FORM exhibit26e2.htm - Generated by SEC Publisher for SEC Filing
Exhibit 26(e)(2):  Fund Allocation of Premium Payments Form (Form No. 139191)
    Life 
 
FUND ALLOCATION OF PREMIUM PAYMENTS   
 
Security Life of Denver Insurance Company, Denver, CO     
A member of the ING family of companies     
ING Customer Service Center: PO Box 5065, Minot, ND 58702-5065  Your future. Made easier.® 
 
Product  Policy Number/List Bill Number 
A. PREMIUM ALLOCATION     
Initial or Future Premium Allocations: Current investment allocations remain the same. See Section D for Investment Transfer Request. 
Premium Allocation: Please allocate your premium among the investment options of the Separate Account and/or to the Guaranteed Interest Division. 
Please use whole number percentages for each division/option elected. You must allocate at least 1% of your premium allocation to each division/option 
in which you elect to invest. The total must equal 100%. For all premium allocation rules, please refer to the prospectuses. 
CA Residents age 60 and older: Unless you tell us otherwise, during the 30 day free look period we allocate your initial net premium to the money 
market investment option. At the end of the free look period, we automatically reallocate your policy value among the various investment options 
according to the allocation instructions on this form. For more information, please see your policy and prospectus, ask your representative or contact the 
ING Customer Service Center.     
 
_______% Guaranteed Interest Division 1     
American Funds Insurance Series  _______% ING Retirement Growth - Class I (RGI) 
_______% American Growth - Class 2 (AFR)  _______% ING Retirement Moderate Growth - Class I (RMG) 
_______% American Growth-Income - Class 2 (AFG)  _______% ING Retirement Moderate - Class I (RMP) 
_______% American International - Class 2 (AFI)  _______% ING T. Rowe Price Capital Appreciation - Class I (GFM) 
BlackRock Variable Series Funds, Inc.  _______% ING T. Rowe Price Equity Income - Class I (TEI) 
_______% BlackRock Global Allocation V.I. - Class III (BGA)  _______% ING U.S. Stock Index - Class I (ISP) 
Fidelity® Variable Insurance Products  _______% ING Van Kampen Growth and Income - Class S (GRD) 
_______% Fidelity® VIP Contrafund® - Initial Class (FCF) 2  _______% ING Wells Fargo Health Care - Class I (EHS) 
_______% Fidelity® VIP Contrafund® - Service Class (FCS) 3  ING Partners, Inc.   
_______% Fidelity® VIP Equity-Income - Initial Class (FEI) 2  _______% ING Baron Small Cap Growth - Initial Class (BSC) 
_______% Fidelity® VIP Equity-Income - Service Class (FSE) 3  _______% ING Columbia Small Cap Value - Initial Class (CSI) 
ING Balanced Portfolio, Inc.  _______% ING JPMorgan Mid Cap Value - Initial Class (MCV) 
_______% ING Balanced - Class I (VBI)  _______% ING Oppenheimer Global - Initial Class (GGP) 
ING Intermediate Bond Portfolio  _______% ING Oppenheimer Global Strategic Income - Service Class (OSI) 
_______% ING Intermediate Bond - Class I (VPB)  _______% ING Pioneer High Yield - Inital Class (PHP) 
ING Investors Trust  _______% ING T. Rowe Price Diversified Mid Cap Growth - Initial Class (DMI) 
_______% ING Artio Foreign - Class I (JBF)  _______% ING UBS U.S. Large Cap Equity - Initial Class (ULI) 
_______% ING BlackRock Large Cap Growth - Class I (GFG)  _______% ING Van Kampen Comstock - Initial Class (VKC) 
_______% ING Clarion Global Real Estate - Class S (IGT)  _______% ING Van Kampen Equity and Income - Initial Class (UTA) 
_______% ING DFA Global Allocation - Class I (DGA)  ING Variable Funds   
_______% ING DFA World Equity - Class I (IFO)  _______% ING Growth and Income - Class I (GIP) 
_______% ING FMRSM Diversified Mid Cap - Class I (FDI)  ING Variable Portfolios, Inc. 
_______% ING Franklin Templeton Founding Strategy - Class I (IFT)  _______% ING Index Plus LargeCap - Class I (IPL) 
_______% ING Global Resources - Class I (IHA)  _______% ING Index Plus MidCap - Class I (IPM) 
_______% ING JPMorgan Emerging Markets Equity - Class I (JEI)  _______% ING Index Plus SmallCap - Class I (IPS) 
_______% ING JPMorgan Small Cap Core Equity - Class I (IJS)  _______% ING International Index - Class S (III) 
_______% ING Large Cap Growth - Class I (EOP)  _______% ING Russell™ Large Cap Growth Index - Class I (IRC) 
_______% ING Limited Maturity Bond - Class S (ILM)  _______% ING Russell™ Large Cap Index - Class I (IRI) 
_______% ING Liquid Assets - Class I (ILP) 4  _______% ING Russell™ Large Cap Value Index - Class I (IRV) 
_______% ING Liquid Assets - Class S (ILA) 5  _______% ING Russell™ Mid Cap Growth Index - Class I (IRM) 
_______% ING Marsico Growth - Class I (IMG)  _______% ING Russell™ Small Cap Index - Class I (IRS) 
_______% ING Marsico International Opportunities - Class I (MIO)  _______% ING Small Company - Class S (ISS) 
_______% ING MFS Total Return - Class I (IMT)  _______% ING U.S. Bond Index - Class I (ILB) 
_______% ING MFS Utilities - Class S (MUP)  ING Variable Products Trust 
_______% ING PIMCO Total Return Bond - Class I (IPC)  _______% ING SmallCap Opportunities - Class I (NIG) 
_______% ING Pioneer Fund - Class I (PFS)  Neuberger Berman Advisers Management Trust 
_______% ING Pioneer Mid Cap Value - Class I (PMV)  _______% Neuberger Berman AMT Socially Responsive® - Class I (NSR) 
Designated Deduction Option: You may designate one investment option from which you want charges taken. If no investment option is designated or 
there is insufficient value in the option, charges will be deducted in proportion to the value invested in each investment option on the date of the charge. 
Investment Option Name     
Page 1 of 6 (Note: Signature required on last page.)  Order #139191 08/23/2010 

 



Product  Policy Number/List Bill Number 
B. AUTOMATIC REBALANCING OPTION (Automatically rebalances the Accumulation Value periodically to maintain a specified percentage 
allocation among the selected Sub-Accounts or Guaranteed Interest Division.) 
Complete allocation below: F Initiate Automatic Rebalancing  F Change Automatic Rebalancing 

 

_______% Guaranteed Interest Division 1       
  American Funds Insurance Series    _______% ING Retirement Growth - Class I (RGI) 
_______% American Growth - Class 2 (AFR)    _______% ING Retirement Moderate Growth - Class I (RMG) 
_______% American Growth-Income - Class 2 (AFG)  _______% ING Retirement Moderate - Class I (RMP) 
_______% American International - Class 2 (AFI)    _______% ING T. Rowe Price Capital Appreciation - Class I (GFM) 
  BlackRock Variable Series Funds, Inc.  _______% ING T. Rowe Price Equity Income - Class I (TEI) 
_______% BlackRock Global Allocation V.I. - Class III (BGA)  _______% ING U.S. Stock Index - Class I (ISP) 
  Fidelity® Variable Insurance Products  _______% ING Van Kampen Growth and Income - Class S (GRD) 
_______% Fidelity® VIP Contrafund® - Initial Class (FCF) 2  _______% ING Wells Fargo Health Care - Class I (EHS) 
_______% Fidelity® VIP Contrafund® - Service Class (FCS) 3  ING Partners, Inc.   
_______% Fidelity® VIP Equity-Income - Initial Class (FEI) 2  _______% ING Baron Small Cap Growth - Initial Class (BSC) 
_______% Fidelity® VIP Equity-Income - Service Class (FSE) 3  _______% ING Columbia Small Cap Value - Initial Class (CSI) 
  ING Balanced Portfolio, Inc.    _______% ING JPMorgan Mid Cap Value - Initial Class (MCV) 
_______% ING Balanced - Class I (VBI)    _______% ING Oppenheimer Global - Initial Class (GGP) 
  ING Intermediate Bond Portfolio    _______% ING Oppenheimer Global Strategic Income - Service Class (OSI) 
_______% ING Intermediate Bond - Class I (VPB)    _______% ING Pioneer High Yield - Inital Class (PHP) 
  ING Investors Trust    _______% ING T. Rowe Price Diversified Mid Cap Growth - Initial Class (DMI) 
_______% ING Artio Foreign - Class I (JBF)    _______% ING UBS U.S. Large Cap Equity - Initial Class (ULI) 
_______% ING BlackRock Large Cap Growth - Class I (GFG)  _______% ING Van Kampen Comstock - Initial Class (VKC) 
_______% ING Clarion Global Real Estate - Class S (IGT)  _______% ING Van Kampen Equity and Income - Initial Class (UTA) 
_______% ING DFA Global Allocation - Class I (DGA)  ING Variable Funds   
_______% ING DFA World Equity - Class I (IFO)    _______% ING Growth and Income - Class I (GIP) 
_______% ING FMRSM Diversified Mid Cap - Class I (FDI)  ING Variable Portfolios, Inc.   
_______% ING Franklin Templeton Founding Strategy - Class I (IFT)  _______% ING Index Plus LargeCap - Class I (IPL) 
_______% ING Global Resources - Class I (IHA)    _______% ING Index Plus MidCap - Class I (IPM) 
_______% ING JPMorgan Emerging Markets Equity - Class I (JEI)  _______% ING Index Plus SmallCap - Class I (IPS) 
_______% ING JPMorgan Small Cap Core Equity - Class I (IJS)  _______% ING International Index - Class S (III) 
_______% ING Large Cap Growth - Class I (EOP)    _______% ING Russell™ Large Cap Growth Index - Class I (IRC) 
_______% ING Limited Maturity Bond - Class S (ILM)  _______% ING Russell™ Large Cap Index - Class I (IRI) 
_______% ING Liquid Assets - Class I (ILP) 4    _______% ING Russell™ Large Cap Value Index - Class I (IRV) 
_______% ING Liquid Assets - Class S (ILA) 5    _______% ING Russell™ Mid Cap Growth Index - Class I (IRM) 
_______% ING Marsico Growth - Class I (IMG)    _______% ING Russell™ Small Cap Index - Class I (IRS) 
_______% ING Marsico International Opportunities - Class I (MIO)  _______% ING Small Company - Class S (ISS) 
_______% ING MFS Total Return - Class I (IMT)    _______% ING U.S. Bond Index - Class I (ILB) 
_______% ING MFS Utilities - Class S (MUP)    ING Variable Products Trust   
_______% ING PIMCO Total Return Bond - Class I (IPC)  _______% ING SmallCap Opportunities - Class I (NIG) 
_______% ING Pioneer Fund - Class I (PFS)         Neuberger Berman Advisers Management Trust 
_______% ING Pioneer Mid Cap Value - Class I (PMV)  _______% Neuberger Berman AMT Socially Responsive® - Class I (NSR) 
Frequency and Date of Automatic Rebalancing  (If no options are marked, frequency will be quarterly and/or date will be last valuation of calendar period.) 
Frequency:  F Monthly  F Quarterly  F Semi-annually  F Annually   
Date:  F Policy Processing Date: Date on which processing will occur based on frequency selected beginning   
  Last Valuation Date of Calendar Period     
  Specific Date of each Period beginning     
Terminate an Existing Automatic Rebalancing Service     
Please terminate my Portfolio Rebalancing Service immediately. (initial here)   
    Page 2 of 6 (Note: Signature required on last page.)  Order #139191 08/23/2010 

 



Product  Policy Number/List Bill Number 
 
C. DOLLAR COST AVERAGING OPTION  (Systematic method of investing, where securities are purchased at regular intervals so the cost of the 
securities is averaged over time.)   
The policyowner must have at least $10,000 invested in the source fund in order to initiate Dollar Cost Averaging. 
Please transfer $__________________ or __________________% from: F ING Liquid Assets Portfolio F ING Limited Maturity Bond Portfolio 

 

American Funds Insurance Series
$__________________ or __________________%  American Growth - Class 2 (AFR)     
$__________________ or __________________%  American Growth-Income - Class 2 (AFG)     
$__________________ or __________________%  American International - Class 2 (AFI)     
  BlackRock Variable Series Funds, Inc.     
$__________________ or __________________%  BlackRock Global Allocation V.I. - Class III (BGA)     
  Fidelity® Variable Insurance Products     
$__________________ or __________________%  Fidelity® VIP Contrafund® - Initial Class (FCF) 2     
$__________________ or __________________%  Fidelity® VIP Contrafund® - Service Class (FCS) 3     
$__________________ or __________________%  Fidelity® VIP Equity-Income - Initial Class (FEI) 2     
$__________________ or __________________%  Fidelity® VIP Equity-Income - Service Class (FSE) 3     
  ING Balanced Portfolio, Inc.     
$__________________ or __________________%  ING Balanced - Class I (VBI)     
ING Intermediate Bond Portfolio
$__________________ or __________________%  ING Intermediate Bond - Class I (VPB)     
  ING Investors Trust     
$__________________ or __________________%  ING Artio Foreign - Class I (JBF)     
$__________________ or __________________%  ING BlackRock Large Cap Growth - Class I (GFG)     
$__________________ or __________________%  ING Clarion Global Real Estate - Class S (IGT)     
$__________________ or __________________%  ING DFA Global Allocation - Class I (DGA)     
$__________________ or __________________%  ING DFA World Equity - Class I (IFO)     
$__________________ or __________________%  ING FMRSM Diversified Mid Cap - Class I (FDI)     
$__________________ or __________________%  ING Franklin Templeton Founding Strategy - Class I (IFT)     
$__________________ or __________________%  ING Global Resources - Class I (IHA)     
$__________________ or __________________%  ING JPMorgan Emerging Markets Equity - Class I (JEI)     
$__________________ or __________________%  ING JPMorgan Small Cap Core Equity - Class I (IJS)     
$__________________ or __________________%  ING Large Cap Growth - Class I (EOP)     
$__________________ or __________________%  ING Limited Maturity Bond - Class S (ILM)     
$__________________ or __________________%  ING Liquid Assets - Class I (ILP) 4     
$__________________ or __________________%  ING Liquid Assets - Class S (ILA) 5     
$__________________ or __________________%  ING Marsico Growth - Class I (IMG)     
$__________________ or __________________%  ING Marsico International Opportunities - Class I (MIO)     
$__________________ or __________________%  ING MFS Total Return - Class I (IMT)     
$__________________ or __________________%  ING MFS Utilities - Class S (MUP)     
$__________________ or __________________%  ING PIMCO Total Return Bond - Class I (IPC)     
$__________________ or __________________%  ING Pioneer Fund - Class I (PFS)     
$__________________ or __________________%  ING Pioneer Mid Cap Value - Class I (PMV)     
$__________________ or __________________%  ING Retirement Growth - Class I (RGI)     
$__________________ or __________________%  ING Retirement Moderate Growth - Class I (RGM)     
$__________________ or __________________%  ING Retirement Moderate - Class I (RMP)     
(DOLLAR COST AVERAGING OPTION - Continued on next page)     
Page 3 of 6 (Note: Signature required on last page.)  Order #139191  08/23/2010 

 



Product      Policy Number/List Bill Number   
C. DOLLAR COST AVERAGING OPTION (Continued)     
 
$__________________ or __________________%  ING T. Rowe Price Capital Appreciation - Class I (GFM)   
$__________________ or __________________%  ING T. Rowe Price Equity Income - Class I (TEI)   
$__________________ or __________________%  ING U.S. Stock Index - Class I (ISP)   
$__________________ or __________________%  ING Van Kampen Growth and Income - Class S (GRD)   
$__________________ or __________________%  ING Wells Fargo Health Care - Class I (EHS)   
    ING Partners, Inc.   
$__________________ or __________________%  ING Baron Small Cap Growth - Initial Class (BSC)   
$__________________ or __________________%  ING Columbia Small Cap Value - Initial Class (CSI)   
$__________________ or __________________%  ING JPMorgan Mid Cap Value - Initial Class (MCV)   
$__________________ or __________________%  ING Oppenheimer Global - Initial Class (GGP)   
$__________________ or __________________%  ING Oppenheimer Global Strategic Income - Service Class (OSI)   
$__________________ or __________________%  ING Pioneer High Yield - Inital Class (PHP)   
$__________________ or __________________%  ING T. Rowe Price Diversified Mid Cap Growth - Initial Class (DMI)   
$__________________ or __________________%  ING UBS U.S. Large Cap Equity - Initial Class (ULI)   
$__________________ or __________________%  ING Van Kampen Comstock - Initial Class (VKC)   
$__________________ or __________________%  ING Van Kampen Equity and Income - Initial Class (UTA)   
    ING Variable Funds   
$__________________ or __________________%  ING Growth and Income - Class I (GIP)   
    ING Variable Portfolios, Inc.   
$__________________ or __________________%  ING Index Plus LargeCap - Class I (IPL)   
$__________________ or __________________%  ING Index Plus MidCap - Class I (IPM)   
$__________________ or __________________%  ING Index Plus SmallCap - Class I (IPS)   
$__________________ or __________________%  ING International Index - Class S (III)   
$__________________ or __________________%  ING Russell™ Large Cap Growth Index - Class I (IRC)   
$__________________ or __________________%  ING Russell™ Large Cap Index - Class I (IRI)   
$__________________ or __________________%  ING Russell™ Large Cap Value Index - Class I (IRV)   
$__________________ or __________________%  ING Russell™ Mid Cap Growth Index - Class I (IRM)   
$__________________ or __________________%  ING Russell™ Small Cap Index - Class I (IRS)   
$__________________ or __________________%  ING Small Company - Class S (ISS)   
$__________________ or __________________%  ING U.S. Bond Index - Class I (ILB)   
    ING Variable Products Trust   
$__________________ or __________________%  ING SmallCap Opportunities - Class I (NIG)   
    Neuberger Berman Advisers Management Trust   
$__________________ or __________________%  Neuberger Berman AMT Socially Responsive® - Class I (NSR)   
Frequency and Date of Dollar Cost Averaging (If no options are marked, frequency will be monthly and/or date will be policy processing date.) 
Frequency:  F Monthly F Quarterly F Semi-annually F Annually   
Date:  F Policy Processing Date: Date on which processing will occur based on frequency selected beginning   
  Specific Date of each Period beginning     
Terminate an Existing Dollar Cost Averaging Service     
FTerminate Dollar Cost Averaging on       
FTerminate Dollar Cost Averaging when investment option from which money is being transferred reaches $   
F Please terminate my Dollar Cost Averaging Service immediately. (initial here)   
Page 4 of 6 (Note: Signature required on last page.)  Order #139191 08/23/2010 

 



Product  Policy Number/List Bill Number 
 
D. INVESTMENT TRANSFER REQUEST   
F Current Investment Only F Current and Future Investments (If no box is checked, Current Investment Only is assumed.) 
If no information is provided in the “Transfer From” column, we will assume that all amounts currently allocated to the investment options, excluding amounts 
allocated to the Guaranteed Interest Division, will be reallocated as requested in the “Transfer To” column. Funds that are closed to new assets are indicated 
with "N/A" in the "Transfer To" column.   

 

Transfer From  Investment Option  Transfer To 
$__________________ or _________%  Guaranteed Interest Division 1  $__________________ or _________% 
  American Funds Insurance Series   
$__________________ or _________%  American Growth - Class 2 (AFR)  $__________________ or _________% 
$__________________ or _________%  American Growth-Income - Class 2 (AFG)  $__________________ or _________% 
$__________________ or _________%  American International - Class 2 (AFI)  $__________________ or _________% 
  BlackRock Variable Series Funds, Inc.   
$__________________ or _________%  BlackRock Global Allocation V.I. - Class III (BGA)  $__________________ or _________% 
  Fidelity® Variable Insurance Products   
$__________________ or _________%  Fidelity® VIP Contrafund® - Initial Class (FCF) 2  $__________________ or _________% 
$__________________ or _________%  Fidelity® VIP Contrafund® - Service Class (FCS) 3  $__________________ or _________% 
$__________________ or _________%  Fidelity® VIP Equity-Income - Initial Class (FEI) 2  $__________________ or _________% 
$__________________ or _________%  Fidelity® VIP Equity-Income - Service Class (FSE) 3  $__________________ or _________% 
$__________________ or _________%  Fidelity® VIP Investment Grade Bond - Initial Class (FIG) 6  N/A 
  ING Balanced Portfolio, Inc.   
$__________________ or _________%  ING Balanced - Class I (VBI)  $__________________ or _________% 
  ING Intermediate Bond Portfolio   
$__________________ or _________%  ING Intermediate Bond - Class I (VPB)  $__________________ or _________% 
  ING Investors Trust   
$__________________ or _________%  ING Artio Foreign - Class I (JBF)  $__________________ or _________% 
$__________________ or _________%  ING BlackRock Large Cap Growth - Class I (GFG)  $__________________ or _________% 
$__________________ or _________%  ING BlackRock Large Cap Value - Class I (IMF) 6  N/A 
$__________________ or _________%  ING Clarion Global Real Estate - Class S (IGT)  $__________________ or _________% 
$__________________ or _________%  ING Clarion Real Estate - Class I (IVK) 7  N/A 
$__________________ or _________%  ING DFA Global Allocation - Class I (DGA)  $__________________ or _________% 
$__________________ or _________%  ING DFA World Equity - Class I (IFO)  $__________________ or _________% 
$__________________ or _________%  ING FMRSM Diversified Mid Cap - Class I (FDI)  $__________________ or _________% 
$__________________ or _________%  ING Franklin Templeton Founding Strategy - Class I (IFT)  $__________________ or _________% 
$__________________ or _________%  ING Global Resources - Class I (IHA)  $__________________ or _________% 
$__________________ or _________%  ING JPMorgan Emerging Markets Equity - Class I (JEI)  $__________________ or _________% 
$__________________ or _________%  ING JPMorgan Small Cap Core Equity - Class I (IJS)  $__________________ or _________% 
$__________________ or _________%  ING Large Cap Growth - Class I (EOP)  $__________________ or _________% 
$__________________ or _________%  ING Limited Maturity Bond - Class S (ILM)  $__________________ or _________% 
$__________________ or _________%  ING Liquid Assets - Class I (ILP) 4  $__________________ or _________% 
$__________________ or _________%  ING Liquid Assets - Class S (ILA) 5  $__________________ or _________% 
$__________________ or _________%  ING Lord Abbett Growth and Income - Class I (ISI) 6  N/A 
$__________________ or _________%  ING Marsico Growth - Class I (IMG)  $__________________ or _________% 
$__________________ or _________%  ING Marsico International Opportunities - Class I (MIO)  $__________________ or _________% 
$__________________ or _________%  ING MFS Total Return - Class I (IMT)  $__________________ or _________% 
$__________________ or _________%  ING MFS Utilities - Class S (MUP)  $__________________ or _________% 
$__________________ or _________%  ING PIMCO Total Return Bond - Class I (IPC)  $__________________ or _________% 
$__________________ or _________%  ING Pioneer Fund - Class I (PFS)  $__________________ or _________% 
$__________________ or _________%  ING Pioneer Mid Cap Value - Class I (PMV)  $__________________ or _________% 
$__________________ or _________%  ING Retirement Growth - Class I (RGI)  $__________________ or _________% 
$__________________ or _________%  ING Retirement Moderate Growth - Class I (RMG)  $__________________ or _________% 
$__________________ or _________%  ING Retirement Moderate - Class I (RMP)  $__________________ or _________% 
$__________________ or _________%  ING T. Rowe Price Capital Appreciation - Class I (GFM)  $__________________ or _________% 
$__________________ or _________%  ING T. Rowe Price Equity Income - Class I (TEI)  $__________________ or _________% 
$__________________ or _________%  ING U.S. Stock Index - Class I (ISP)  $__________________ or _________% 
$__________________ or _________%  ING Van Kampen Growth and Income - Class S (GRD)  $__________________ or _________% 
$__________________ or _________%  ING Wells Fargo Health Care - Class I (EHS)  $__________________ or _________% 
  ING Partners, Inc.   
$__________________ or _________%  ING American Century Small-Mid Cap Value - Initial Class (SCV) 6  N/A 
$__________________ or _________%  ING Baron Small Cap Growth - Initial Class (BSC)  $__________________ or _________% 
$__________________ or _________%  ING Columbia Small Cap Value - Initial Class (CSI)  $__________________ or _________% 
$__________________ or _________%  ING JPMorgan Mid Cap Value - Initial Class (MCV)  $__________________ or _________% 
$__________________ or _________%  ING Legg Mason ClearBridge Aggressive Growth - Initial Class (ISA) 6  N/A 
(INVESTMENT TRANSFER REQUEST - Continued on next page)   
Page 5 of 6 (Note: Signature required on last page.)  Order #139191 08/23/2010 

 


Daytime Phone 
D. INVESTMENT TRANSFER REQUEST (Continued)     
 
Transfer From  Investment Option    Transfer To 
$__________________ or _________%  ING Oppenheimer Global - Initial Class (GGP)    $__________________ or _________% 
$__________________ or _________%  ING Oppenheimer Global Strategic Income - Class S (OSI)  $__________________ or _________% 
$__________________ or _________%  ING PIMCO Total Return - Initial Class (PTR) 8    N/A 
$__________________ or _________%  ING Pioneer High Yield - Inital Class (PHP)    $__________________ or _________% 
$__________________ or _________% ING T. Rowe Price Diversified Mid Cap Growth - Initial Class (DMI)     $__________________ or _________%
$__________________ or _________%  ING UBS U.S. Large Cap Equity - Initial Class (ULI)    $__________________ or _________% 
$__________________ or _________%  ING Van Kampen Comstock - Initial Class (VKC)    $__________________ or _________% 
$__________________ or _________%  ING Van Kampen Equity and Income - Initial Class (UTA)  $__________________ or _________% 
  ING Strategic Allocation Portfolio     
$__________________ or _________%  ING Strategic Allocation Conservative - Class I (SAI) 6    N/A 
$__________________ or _________%  ING Strategic Allocation Growth - Class I (SAG) 6    N/A 
$__________________ or _________%  ING Strategic Allocation Moderate - Class I (SAB) 6    N/A 
  ING Variable Funds     
$__________________ or _________%  ING Growth and Income - Class I (GIP)    $__________________ or _________% 
  ING Variable Portfolios, Inc.     
$__________________ or _________%  ING Index Plus LargeCap - Class I (IPL)    $__________________ or _________% 
$__________________ or _________%  ING Index Plus MidCap - Class I (IPM)    $__________________ or _________% 
$__________________ or _________%  ING Index Plus SmallCap - Class I (IPS)    $__________________ or _________% 
$__________________ or _________%  ING International Index - Class S (III)    $__________________ or _________% 
$__________________ or _________%  ING Russell™ Large Cap Growth Index - Class I (IRC)    $__________________ or _________% 
$__________________ or _________%  ING Russell™ Large Cap Index - Class I (IRI)    $__________________ or _________% 
$__________________ or _________%  ING Russell™ Large Cap Value Index - Class I (IRV)    $__________________ or _________% 
$__________________ or _________%  ING Russell™ Mid Cap Growth Index - Class I (IRM)    $__________________ or _________% 
$__________________ or _________%  ING Russell™ Small Cap Index - Class I (IRS)    $__________________ or _________% 
$__________________ or _________%  ING Small Company - Class S (ISS)    $__________________ or _________% 
$__________________ or _________%  ING U.S. Bond Index - Class I (ILB)    $__________________ or _________% 
  ING Variable Products Trust     
$__________________ or _________%  ING MidCap Opportunities - Class I (PMO) 6    N/A 
$__________________ or _________%  ING SmallCap Opportunities - Class I (NIG)    $__________________ or _________% 
  Invesco Variable Insurance Funds     
$__________________ or _________%  Invesco V.I. Core Equity Fund - Series I (ACE) 6    N/A 
  Neuberger Berman Advisers Management Trust     
$__________________ or _________%  Neuberger Berman AMT Socially Responsive® - Class I (NSR)  $__________________ or _________% 
  Van Eck     
$__________________ or _________%  Van Eck VIP Global Hard Assets Fund (WHA) 9    N/A 
 
Endnotes       
1 Transfers to and from the Guaranteed Interest Division have specific time and amount limitations. Please refer to your policy or prospectus for additional information. 
2 Only available with Future Dimensions.       
3 Not available with Future Dimensions.       
4 Not available with Asset Accumulator, Asset Portfolio Manager, Corporate Benefits, ING Corporate VUL, ING SVUL-CV, ING VUL-CV, ING VUL-ECV, Market Dimensions, 
  Strategic Investor or Survivor Dimensions.       
5 Not available with Estate Designer, FirstLine, FirstLine II, Future Dimensions, Strategic Advantage, Strategic Advantage II or Variable Survivorship. 
6 Not available with ING Corporate VUL, ING SVUL-CV, ING VUL-CV or ING VUL-ECV.     
7 Only available with Future Dimensions, Market Dimensions and Survivor Dimensions.     
8 Not available with ING SVUL-CV or ING VUL-ECV.     
9 Not available with Corporate Benefits, Future Dimensions, ING Corporate VUL, ING SVUL-CV, ING VUL-CV, ING VUL-ECV, Market Dimensions or Survivor Dimensions. 
 
E. SIGNATURES (If Owner is a Corporation, Trust, or Partnership, signature and title of Officer is required.) 
I/We acknowledge that we have read and understand: 1. the terms and conditions listed in the instructions to this form and that we have received and read the Prospectus 
for this policy. 2. I/we can cancel or change any elections requested in Sections B and C above by sending written notice to the ING Customer Service Center before the 
next transfer date. 3. that Dollar Cost Averaging and Automatic Rebalancing will begin on the date specified only if the ING Customer Service Center has received and 
accepted this signed form before the date specified.     
Owner(s) Name       
 
Owner(s) Signature      Date 
 
Registered Representative Name       
 
Registered Signature Representative     Date
Spouse Signature (if applicable)                                                                                                                                   Date
Insured(s) Name       
 
Policy Number/List Bill Number 10    Daytime Phone   (     )   
10 For corporate owned/sponsored plans, please attach list of applicable policies.     
  Page 6 of 6    Order #139192 08/23/2010