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EXHIBIT 5
First SunAmerica New Business Documents Overnight With Checks
Life Insurance Company With Checks BONPC
733 Third Avenue P. O. Box 100330 1111 Arroyo Parkway
New York, New York 10017 Pasadena, CA 91189-0001 Suite 150
Without Checks: Lockbox # 100357
P.O. Box 54299 Pasadena, CA 91105
Los Angeles, CA 90054-0299
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DEFERRED ANNUITY APPLICATION FSA-503 (02/00)
Do Not Use Highlighter. PLEASE PRINT OR TYPE.
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A. OWNER
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Last Name First Name Middle Initial
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Street Address
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City State Zip Code
Mo. Day Year [ ]M [ ]F ( )
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Date Of Birth Sex SSN or TIN Telephone Number
JOINT OWNER (If Applicable):
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Last Name First Name Middle Initial
Mo. Day Year [ ]M [ ]F ( )
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Date of Birth Sex SSN Relationship to Owner Telephone Number
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B. ANNUITANT (Complete only if different from Owner)
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Last Name First Name Middle Initial
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Street Address
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City State Zip Code
Mo. Day Year [ ]M [ ]F ( )
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Date Of Birth Sex SSN Telephone Number
JOINT ANNUITANT (If Applicable):
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Last Name First Name Middle Initial
Mo. Day Year [ ]M [ ]F ( )
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Date Of Birth Sex SSN Telephone Number
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C. BENEFICIARY (Please list additional beneficiaries, if any, in the special
instructions section)
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[X]Primary
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Last Name First Name M I Relationship Percentage
[ ]Primary [ ]Contingent
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Last Name First Name M I Relationship Percentage
[ ]Primary [ ]Contingent
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Last Name First Name M I Relationship Percentage
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D. TYPE OF CONTRACT (If this is a transfer or 1035 Exchange, please complete
form [F-2500NB] and submit it with this application)
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[ ]NON-QUALIFIED CONTRACT (MINIMUM $10,000)
[ ]QUALIFIED CONTRACT (MINIMUM $10,000)
PLEASE INDICATE SPECIFIC CONTRACT TYPE BELOW:
[ ] IRA TRANSFER [ ] IRA ROLLOVER
[ ] ROTH IRA [ ] OTHER_________
[ ] Check included with this application for $_____________
(OVER)
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E. ANNUITY DATE: Date annuity payments ("income payments") begin. (Must be at
least 2 years after the Contract Date but not beyond the Annuitant's 90th
birthday. NOTE: If left blank, the Annuity Date will default to the maximum for
nonqualified and to 70 1/2 for qualified contracts.)
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Month Day Year
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F. ADDITIONAL INSTRUCTIONS (Additional Beneficiaries, Transfer Company
Information; etc.)
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G. INVESTMENT INSTRUCTIONS (Allocations must be expressed in whole percentages
and the total allocation must equal 100%)
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<TABLE>
<CAPTION>
PAYMENT
ALLOCATIONS
STOCK PORTFOLIO MANAGER
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<S> <C> <C>
_____% Alliance Growth Alliance Capital Mgmt. L.P.
_____% Global Equities Alliance Capital Mgmt. L.P.
_____% Growth-Income Alliance Capital Mgmt. L.P.
_____% Davis Venture Value Davis Selected Advisors, L.P.
_____% Federated Value Federated Investors
_____% Goldman Sachs Research Goldman Sachs Asset Mgmt.
_____% MFS Growth & Income Massachusetts Financial Services Co.
_____% MFS Mid-Cap Growth Massachusetts Financial Services Co.
_____% Int'l Diversified Equities Morgan Stanley Asset Mgmt.
_____% Technology Morgan Stanley Asset Mgmt.
_____% Emerging Markets Putnam Investment Mgmt., Inc.
_____% Int'l Growth and Income Putnam Investment Mgmt., Inc.
_____% Putnam Growth Putnam Investment Mgmt., Inc.
_____% Aggressive Growth SunAmerica Asset Mgmt. Corp.
_____% Blue Chip Growth SunAmerica Asset Mgmt. Corp.
_____% Growth Opportunities SunAmerica Asset Mgmt. Corp.
_____% Capital Appreciation Wellington Mgmt. Co., LLP
_____% Growth Wellington Mgmt. Co., LLP
</TABLE>
<TABLE>
<CAPTION>
PAYMENT
ALLOCATIONS
BOND PORTFOLIO MANAGER
---- --------- -------
<S> <C> <C>
_____% Corporate Bond Federated Investors
_____% Global Bond Goldman Sachs Asset Mgmt., Intl.
_____% Worldwide High Inc Morgan Stanley Asset Mgmt.
_____% High-Yield Bond SunAmerica Asset Mgmt. Corp.
_____% Gov't & Quality Bond Wellington Mgmt. Co., LLP
BALANCED
_____% Asset Allocation Goldman Sachs Asset Mgmt.
_____% MFS Total Return Massachusetts Financial Services Co.
_____% SunAmerica Balanced SunAmerica Asset Mgmt. Corp.
CASH
_____% Cash Management SunAmerica Asset Mgmt. Corp.
FIXED ACCOUNT OPTION
_____% 1-Year Fixed Account
</TABLE>
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H. STATEMENT OF OWNER
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Will this contract replace an existing life insurance or annuity contract?
[ ] Yes [ ] No (If yes, please attach transfer forms, replacement forms and
indicate below, the name of the existing issuing company and the contract
number.)
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Company Name Contract Number
I hereby represent my answers to the above questions to be correct and true to
the best of my knowledge and belief and agree that this Application Form shall
be a part of any Contract issued by the Company. I VERIFY MY UNDERSTANDING THAT
THE PURCHASE PAYMENT AND VALUES PROVIDED BY THE CONTRACT, WHEN BASED ON
INVESTMENT EXPERIENCE OF VARIABLE PORTFOLIO(S), ARE VARIABLE AND NOT GUARANTEED
AS TO DOLLAR AMOUNT. IF A RETURN OF THE PURCHASE PAYMENT IS REQUIRED UNDER THE
RIGHT TO EXAMINE PROVISION OF THE CONTRACT, I UNDERSTAND THE COMPANY RESERVES
THE RIGHT TO ALLOCATE MY PURCHASE PAYMENT TO THE CASH MANAGEMENT PORTFOLIO UNTIL
THE END OF THE RIGHT TO EXAMINE PERIOD. I FURTHER UNDERSTAND THAT AT THE END OF
THE RIGHT TO EXAMINE PERIOD, THE COMPANY WILL ALLOCATE MY FUNDS ACCORDING TO MY
INVESTMENT INSTRUCTIONS. I ACKNOWLEDGE RECEIPT OF THE CURRENT PROSPECTUSES FOR
[ADVISOR] VARIABLE ANNUITY THE [SUNAMERICA SERIES TRUST AND ANCHOR SERIES
TRUST]. I HAVE READ THEM CAREFULLY AND UNDERSTAND THEIR CONTENTS. I FURTHER
VERIFY MY UNDERSTANDING THAT THIS VARIABLE ANNUITY IS SUITABLE TO MY OWN
OBJECTIVES AND NEEDS.
Signed at
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City State Date
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Owner's Signature Joint Owner's Signature (If Applicable)
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Registered Representative's Signature
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I. LICENSED / REGISTERED REPRESENTATIVE INFORMATION
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Will this Contract replace in whole or in part any existing life insurance or
annuity contract? [ ] Yes [ ] No
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Printed Name of Registered Representative Social Security Number
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Representative's Street Address City State Zip
( )
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Broker/Dealer Firm Name Representative's Phone Number Licensed Agent ID Number
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For Office Use Only
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