EXHIBIT 1.A.(10)(b)
[LOGO] RELIASTAR
SUPPLEMENT TO RELIASTAR LIFE INSURANCE COMPANY
LIFE INSURANCE APPLICATION P.O. Box 20, Minneapolis, Minnesota 55440
1. DEATH BENEFIT QUALIFICATION TEST: [ ] Guideline Premium Test
[ ] Cash Value Accumulation Test*
2. DEATH BENEFIT OPTION: [ ] Level [ ] Variable [ ] Face Amount Plus Premium*
*not available with all products
3. ALLOCATION OF PREMIUM PAYMENTS: ALLOCATION MUST BE IN WHOLE PERCENTAGE
POINTS TOTALING 100%.
<TABLE>
<S> <C> <C>
a. [ %] Fixed Account (SFA) JANUS ASPEN SERIES OCC ACCUMULATION TRUST
n. [ %] Aggressive Growth cc. [ %] Equity
THE AIM VARIABLE INSURANCE PRODUCTS Portfolio (JAG) Portfolio (OEP)
FUND, INC.
b. [ %] AIM V.I. Dent Demographic o. [ %] Growth dd. [ %] Global Equity
Trends Fund (ADT) Portfolio (JGP) Portfolio (OGE)
THE ALGER AMERICAN FUND p. [ %] International Growth ee. [ %] Managed
c. [ %] Alger American Growth Portfolio (JIG) Portfolio (OMP)
Portfolio (AGR)
q. [ %] Worldwide Growth ff. [ %] Small Cap
d. [ %] Alger American Leveraged Portfolio (JWG) Portfolio (OSC)
AllCap Portfolio (ALA)
e. [ %] Alger American MidCap NEUBERGER BERMAN ADVISERS PUTNAM VARIABLE TRUST
Growth Portfolio (AMG) MANAGEMENT TRUST
r. [ %] Limited Maturity Bond gg. [ %] Putnam VT Growth &
f. [ %] Alger American Small Portfolio (NLM) Income Fund (PGI)
Capitalization Portfolio (ASC)
s. [ %] Partners hh. [ %] Putnam VT New
FIDELITY VARIABLE INSURANCE Portfolio (NPP) Opportunities Fund (PNO)
PRODUCTS FUNDS
t. [ %] Socially Responsive ii. [ %] Putnam VT Voyager
Portfolio (NSR) Fund (PVY)
PILGRIM VARIABLE PRODUCTS TRUST OTHER INVESTMENT COMPANIES/FUNDS
g. [ %] VIP Equity Income u. [ %] VP Growth Opportunities
Portfolio (FEI) Portfolio (PGO) SPECIFY BOTH THE INVESTMENT COMPANY AND
THE FUND NAMES.
h. [ %] VIP Growth v. [ %] VP Growth + Value jj. [ %] [ ]
Portfolio (FGP) Portfolio (NGF)
kk. [ %] [ ]
i. [ %] VIP High Income w. [ %] VP High Yield Bond
Portfolio (FHI) Portfolio (NHY) ll. [ %] [ ]
j. [ %] VIP Money Market x. [ %] VP International Value mm. [ %] [ ]
Portfolio (FMM) Portfolio (NIV)
FIDELITY VARIABLE INSURANCE y. [ %] VP MagnaCap
PRODUCTS FUNDS II Portfolio (PMP)
k. [ %] VIP II Contrafund z. [ %] VP MidCap Opportunities
Portfolio (FCF) Portfolio (PMO)
l. [ %] VIP II Index 500 aa. [ %] VP Research Enhanced
Portfolio (FIN) Index Portfolio (NMS)
m. [ %] VIP II Investment Grade bb. [ %] VP SmallCap Opportunities
Bond Portfolio (FIG) Portfolio (NIG)
</TABLE>
We will allocate all future payments as shown above. You may change this
allocation by giving us written notice.
We reserve the right to limit your participation to a total of seventeen
Sub-Account funds over the lifetime of your Policy. Upon participation in the
seventeenth Sub-Account fund, you would be able to allocate premiums to and
transfer within the seventeen Sub-Account funds already used and which are still
available, but could not participate in any other Sub-Account funds. (This
limitation does not apply to all products.)
I understand and agree that this supplement is part of my application for life
insurance and will be considered part of my Policy with ReliaStar Life
Insurance Company.
Date Signature of Agent Broker Dealer Affiliation
---------- -------------------------------- --------------------------------
Signature of Proposed Owner(s)
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47554b 1-2000
