American Century Life Insurance Company of Texas (a stipulated premium company)

1333 W. McDermott Dr., Suite 150 Allen, TX 75013

Phone (855) 966-1111, Fax (855) 855-0181

SPDA App (08-18)

Single Premium Deferred Annuity ApplicationOwner Annuitant

Full Name: Full Name:

Address: Date of Birth: Age:

City, State, Zip: Gender: M F

Phone #: Address:

Owner’s SS#: City, State, Zip:

Relationship to Annuitant: Phone #:

Email Address: Annuitant’s SS#:

Beneficiaries

Primary Beneficiary: Contingent Beneficiary:

Relationship to Annuitant: Relationship to Annuitant:

Annuity Term & Amount

Single Premium Amount:

Select annuity term and guaranteed interest rate form the options below:

3 years with interest of 2.65% 5 years with interest of 3.65%

7 years with interest of 3.75% 10 years with interest of 3.90%

This annuity is applied for as: Non-Qualified Qualified IRA account Qualified ROTH IRA account

Single Premium Payment

Check – Enclosed is a check or money order for $

Bank Draft – Draft from the following account:

Routing Number: Draft Date:

Account Number: Account Type: Checking Savings

Roll Over – I will roll over another annuity

Account Number: Insurance Company Name:

Account Balance: Phone Number:

Optional Rider – Free Withdrawal Waiver By selecting this rider, the following changes will be made to your annuity: (1) the 10% free withdrawal included in the policy will be waived and any withdrawal of the annuity principal will incur withdrawal charges, and (2) the interest rate credited to your annuity will increase to the rates below:

3 years - 3.00% 5 years - 4.00% 7 years - 4.10% 10 years - 4.20%

I select this rider I decline this rider

American Century Life Insurance Company of Texas (a stipulated premium company)

1333 W. McDermott Dr., Suite 150 Allen, TX 75013

Phone (855) 966-1111, Fax (855) 855-0181

SPDA App (08-18)

Life Insurance and Annuity in Force and Replacement Information Yes No

a. Are there any existing life insurance or annuity contracts with any other Company on the life of the Insured?b. Will the life insurance applied for replace, change, or otherwise reduce in value, any existing life insurance orannuity contract now in force with any other Company? If Yes to either a. or b., provide details below: Insurance Company Policy Number Face Amount Replacement Reason

Agreement • I believe this to be a suitable purchase for my financial status. Any applicable withdrawal and market value adjustment

provisions have been explained to me. I understand that there are no free withdrawals unless a specific waiver applies.• I understand that amounts payable under the contract may be subject to a Market Value Adjustment.• I agree to all terms and conditions as shown, and have read and understand all of the statements made above. I agree

that this application will be made part of the annuity contract, and all statements made in this application are true to thebest of my knowledge and belief.

FRAUD NOTICE: Any person who knowingly presents a false statement in an application for insurance may be guilty of a criminal offense and subject to penalties under state law.

Signature of Applicant/Policy Owner Signature of Annuitant Date

Agent Certification Yes No

1. Did you personally interview the applicant and witnessed all signatures?2. Did you review the application for correctness and any omissions?3. Did the applicant(s) review the application for correctness and any omissions?4. Are you and the insured related?

Send policy to Policy Owner Agent

By signing below, I hereby certify, to the best of my knowledge and belief, that all information in this application is true and accurate. I further certify that I have explained any applicable withdrawal charges, withdrawal and market value adjustment provisions contained in this annuity contract and I have fully and accurately disclosed all of the terms and conditions, including the interest rate structure of the annuity contract to the applicant. I also certify that this annuity is suitable for the applicant, based upon the applicant’s disclosure.

Agent Name Agent Signature Agent Number Date

American Century Life Insurance Company of Texas (a stipulated premium company)

1333 W. McDermott Dr., Suite 150 Allen, TX 75013

Phone (855) 966-1111, Fax (855) 855-0181

SPDA Disclosure (08-18)

CERTIFICATE OF DISCLOSURE GUARANTEE PERIOD/INTEREST CREDITING You choose the guaranteed rate period that is best for you. The guarantee period begins on the date of issue and ends on the last day of the chosen period. After your chosen rate period ends your annuity may be extended to another guarantee period of annuitize and start providing you monthly income. Interest is credited and compounded on a daily basis. The rates shown below are the current effective annual rates.

3 years – 2.65% 5 years – 3.65% 7 years – 3.75% 10 years – 3.90%

KEY ANNUITY TERMS Tax Advantages Although an annuity does not eliminate your tax liability on interest earnings, under current tax law all interest earned accumulated on a tax-deferred basis. Tax deferral is currently available only do individual owners and certain trusts, not to corporations or other non-individuals.

Single Premium Deferred Annuity This annuity is a single premium deferred annuity. Additional premiums may not be added in the future.

No Sales Charges or Fees There are no annual maintenance fees and no front-end sales loads. 100% of your money works for you! However, if applicable, a premium tax will be deducted from your premium (Not applicable in Texas)

Right to Examine Annuity Within the first 30 days after you receive your annuity, you may return the annuity and receive 100% of your premium, minus any prior withdrawals

Minimum/Maximum Premium Issue Ages 0-90 years old $2,000-150,000

Exceptions to Surrender Charges & MVA 1. You may withdraw 100% of your accumulated interest free of all charges at any time2. You may withdraw 10% of the account value each year (including any accumulated interest amount) free of

surrender charges. MVA calculation will apply. This exception may not apply if you selected the Free WithdrawalWaiver rider.

3. Withdrawal charges and MVA are waived in the event of death of the Owner4. You may elect to annuitize at any time after the first year from a number of options. Surrender charges and

MVA are waived with a payout period of 5 years or longer

WITHDRAWAL CHARGES During the Initial Guarantee Period and any Subsequent Guarantee Period, a Withdrawal Charge will be assessed if you make a withdrawal or surrender your contract, unless the surrender charge is waived as explained above.

Year 1 2 3 4 5 6 7 8 9 10 3 Year 9% 8% 7% 5 Year 9% 8% 7% 6% 5% 7 Year 9% 8% 7% 6% 5% 4% 3%

10 Year 9% 8% 7% 6% 5% 4% 3% 2% 1% 0.5%

American Century Life Insurance Company of Texas (a stipulated premium company)

1333 W. McDermott Dr., Suite 150 Allen, TX 75013

Phone (855) 966-1111, Fax (855) 855-0181

SPDA Disclosure (08-18)

Optional Rider – Free Withdrawal Waiver By selecting this rider, the following changes will be made to your annuity: (1) the 10% free withdrawal included in the policy will be waived and any withdrawal of the annuity principal will incur withdrawal charges, and (2) the interest rate credited to your annuity will increase to the rates below:

3 years – 3.00% 5 years – 4.00% 7 years – 4.10% 10 years – 4.20%

MARKET VALUE ADJUSTMENT When you make a withdrawal, we also may increase or decrease the amount you receive based on a market value adjustment (MVA). If interest rates went up after you bought your annuity, the MVA likely will decrease the amount you receive. If interest rates went down, the MVA will likely increase the amount you receive.

TAXES Neither the Company nor its producers give tax advice. Taxes must be paid on deferred earnings when accessed. You may be responsible for income taxes on amounts distributed under the contract, including a 10% penalty for withdrawals prior to age 59½.

RENEWAL OF GUARANTEE PERIOD During the last 30 days before the end of any guarantee period, you may Request one of these options to take effect on the next Contract Anniversary: (1) Keep your contract and earn minimum annual interest of 2% with no Withdrawal Charges or MVA. In this option

interest rate will fluctuate, but will never be below 2% annually. You will be able to withdraw your Account Value at any time without additional Withdrawal Charges or MVA.

(2) Continue Your contract for a Subsequent Guarantee Period of the same duration as the preceding guarantee period and at the applicable Subsequent Guaranteed Interest Rate;

(3) Apply the Account Value to a Settlement Option; (4) Take a partial withdrawal, with MVA and Withdrawal Charge Percentages waived, and apply the remaining value to

a Subsequent Guarantee Period of the same duration as the preceding guarantee period and at the applicable Subsequent Guaranteed Interest Rate; or

(5) Surrender the entire contract with MVA and Withdrawal Charge Percentages waived. We will notify You at least 45 days before the expiration of a guarantee period. Unless You Request one of the options shown above, option (1) above will be elected as the default option for your policy. If Your contract is continued for a Subsequent Guarantee Period (option (2) above), the MVA, applicable Withdrawal Charge Percentage, and Withdrawal Charge Period shown in the Data Section apply to the new guarantee period.

NOTES • This document is not a legal contract. For the exact terms and conditions, please refer to the annuity policy/contract.• Tax laws are subject to varying interpretations and possible changes. Please consult your tax advisor for further

information

CERTIFICATION I have read this Certificate of Disclosure and understand its contents. I understand that maximizing the value of my contract depends on minimizing withdrawals from my contract during any guarantee period. I further understand that this Certificate of Disclosure is only a summary of certain terms of my annuity contract, and that the contract together with the application, when issued, will represent the entire agreement between the Company and me.

Signature of Applicant/Policy Owner Signature of Annuitant Date

A copy of this Certificate of Disclosure will be returned with your annuity contract.

American Century Life Insurance Company of Texas (a stipulated premium company)

1333 W. McDermott Dr., Suite 150 Allen, TX 75013

Phone (855) 966-1111, Fax (855) 855-0181

Annuity Suitability (08-17)

ANNUITY SUITABILITY ANALYSIS

PERSONAL INFORMATION

Owner Spouse (if any) Full Name

Current Age

Gender

Current Occupation

Dependents (number and ages) Employment Status Retired Work Full-Time

Work Part-Time Other ___________ Retired Work Full-Time Work Part-Time Other ___________

FINANCIAL SITUATION AND NEEDS OF OWNER

After the purchase of the annuity, will your income and liquid net worth be enough for living expenses and emergencies? …………………….…………………….…………………….…………………….…………………….…………………….…………….. Yes No (Many financial planners recommend that a person maintain an amount of liquid net worth equal to 3 to 6 months of a person’s monthly living expenses in case of emergencies.) We recommend that you don’t use more than 50% of the assets that you have set aside for retirement to purchase this Annuity, excluding your home. We also recommend you keep at least $25,000 of savings on hand for emergencies. Does the value of this annuity purchase exceed 50% of the client's net worth? …………………….…………………………. Yes No If you are past age 70, have you consulted with a family member before buying this annuity? …………………………. Yes No

Financial Objectives (check all that apply): Asset accumulation Tax deferred growth Immediate income Transfer to heirs Future retirement income Safety of principal Guaranteed interest rate Other:

Period of Time Before Money is Needed:

1-3 years 4-6 years 7-9 years 10-12 years 13 or more years

FUNDS PROFILE

Yes No

Yes No

Yes No

Are funds from an existing life insurance policy or annuity contract being considered for use? ………………….…….. How long have the policy(ies) or contract(s) been inforce?

Will there be a surrender charge associated with the existing funds? …………………….…………………….…………………… If yes, what is the amount of the charge? (approximate value) Do you have any outstanding loans on the existing life insurance or annuity contract(s)? …………………………………. Are you currently receiving Required Minimum Distributions or 72t distributions or taking free or systematic withdrawals from your annuity contract(s)? …………………………………….………………………………………......................... Yes No

Source of Funds for this Annuity Application: CD/Savings/Checking Inheritance Current income Death benefit proceeds Qualified plan distribution Cash value from existing annuity Liquidation of assets Rollover/transfer from qualified account Other:

American Century Life Insurance Company of Texas (a stipulated premium company)

1333 W. McDermott Dr., Suite 150 Allen, TX 75013

Phone (855) 966-1111, Fax (855) 855-0181

Annuity Suitability (08-17)

OWNER’S ACKNOWLEDGMENT

Select A or B below:

A: APPLICANT’S ACKNOWLEDGMENT OF SUITABILITY: I acknowledge that this document has been read to me, or that I have read this document, and fully understand the information and questions contained in this document and that all information provided herein is accurate to the best of my knowledge.

I acknowledge that the annuity product I am applying for is a long-term contract with substantial penalties for early withdrawal. I believe that this product meets my current financial needs and objectives.

B: APPLICANT’S ACKNOWLEDGMENT OF RESPONSIBILITY: I elect NOT to provide financial related information or answers to the above personal financial questions. I have decided to purchase this fixed annuity without a recommendation from my agent or the Company, who cannot make such a recommendation without this information.

I acknowledge that the annuity product I am applying for is a long-term contract with substantial penalties for early withdrawal. I believe that this product meets my current financial needs and objectives.

Applicant’s Signature Applicant’s Name Date

AGENT’S ACKNOWLEDGMENT

Complete A or B below (select the same option the client selected above):

A: I acknowledge that I have reviewed the content of this suitability worksheet and disclosure with my client and have completed a suitability and needs analysis review regarding the purchase of this annuity. Based on information collected, I believe the purchase of this annuity is suitable.

B: The Applicant(s) has not provided complete information and has decided to purchase this fixed annuity without my recommendation.

Agent’s Signature Agent’s Name Date

THIS FORM MUST BE SUBMITTED TO AMERICAN CENTURY LIFE TOGETHER WITH THE APPLICATION

American Century Life Insurance Company of Texas (a stipulated premium company)

1333 W. McDermott Dr., Suite 150 Allen, TX 75013

Phone (855) 966-1111, Fax (855) 855-0181

Annuity Replacement (08-17)

IMPORTANT NOTICE: REPLACEMENT OF LIFE INSURANCE OR ANNUITIES This document must be signed by the applicant and the producer, if there is one, and a copy left with the applicant.

You are contemplating the purchase of a life insurance policy or annuity contract. In some cases this purchase may involve discontinuing or changing an existing policy or contract. If so, a replacement is occurring. Financed purchase are also considered replacements. A replacement occurs when a new policy or contract is purchased and, in connection with the sale, you discontinue making premium payments on an existing policy or contract, or an existing policy or contract is surrendered, forfeited, assigned to the replacing insurer, or otherwise terminated or used in a financed purchase. A financed purchase occurs when the purchase of a new life insurance policy involved the use of funds obtained by the withdrawal or surrender of or by borrowing some or all of the policy values, including accumulated dividends, of an existing policy to pay all or part of any premium or payment due on the new policy. A financed purchase is a replacement. You should carefully consider whether a replacement is in your best interest. You will pay acquisition costs and there may be surrender costs deducted from your policy or contract. You may be able to make changes to your existing policy or contract to meet your insurance needs at less cost. A financed purchase will reduce the value of your existing policy and may reduce the amount paid upon the death of the insured. We want you to understand the effects of replacements before you make your purchase decision and ask that you answer the following questions and consider the questions on the back of this form.

1. Are you considering discontinuing making premium payments, surrendering, forfeiting, assigning to the insurer,or otherwise terminating your existing policy or contract? Yes No

2. Are you considering using funds from your existing policies or contracts to pay premiums due on the new policyor contract? Yes No

If you answered “Yes” to either of the above questions, list each existing policy or contract you are contemplating replacing (including the same of the insurer, the insured or annuitant, and the policy or contract number if available) and whether each policy or contract will be replaced or used as a source of financing.

Insurer Name Contract or policy # Insured or Annuitant Replaced or financing

1.

2.

3.

Make sure you know the facts. Contact your existing company or its agent for information about the old policy or contract. If you request one, an in force illustration, policy summary or available disclosure documents must be sent to you by the existing insurer. Ask for and retain all sales material used by the agent in the sales presentation. Be sure that you are making an informed decision.

The existing policy or contract is being replaced because:

I certify that the responses herein are, to the best of my knowledge, accurate:

Applicant signature Applicant name Date

Agent signature Agents name Date

American Century Life Insurance Company of Texas (a stipulated premium company)

1333 W. McDermott Dr., Suite 150 Allen, TX 75013

Phone (855) 966-1111, Fax (855) 855-0181

Annuity Replacement (08-17)

A replacement may not be in your best interest, or your decision could be a good one. You should make a careful comparison of the costs and benefits of your existing policy or contract and the proposed policy or contract. One way to do this is to ask the company or agents that sold you your existing policy or contract to provide you with information concerning your existing policy or contract. This may include an illustration of how your existing policy or contract is working now and how it would perform in the future based on certain assumptions. Illustrations should not, however, be used as a sole basis to compare policies or contracts. You should discuss the following with your agents to determine whether replacement or financing your purchase makes sense.

PREMIUMS Are they affordable? Could they change? You’re older – are premiums higher for the proposed new policy? How long will you have to pay premiums on the new policy? On the old policy?

POLICY VALUES New policies usually take longer to build cash values and to pay dividends Acquisition costs for the old policy may have been paid, you will incur costs for the new one What surrender charges do the policies have? What expense and sales charges will you pay on the new policy? Does the new policy provide more insurance coverage?

INSURABILITY If your health has changed since you bought your old policy, the new one could cost you more, or you could be turned down You may need a medical exam for a new policy Claims on most new policies for up to the first two years can be denied based on inaccurate statements Suicide limitations may begin anew on the new coverage

IF YOU ARE KEEPING THE OLD POLICY AS WELL AS THE NEW POLICY How are premiums for both policies being paid? How will the premiums on your existing policy be affected? Will a loan be deducted from death benefits? What values from the old policy are being used to pay expenses?

IF YOU ARE SURRENDERING AN ANNUITY OR INTEREST SENSITIVE LIFE PRODUCT Will you pay surrender charges on your old contract? What are the interest rate guarantees for the new contract? Have you compared the contract charges or other policy expenses?

OTHER ISSUES TO CONSIDER FOR ALL TRANSACTIONS What are the tax consequences of buying the new policy? Is this a tax free exchanges? (See your tax advisor.) Is there a benefit from favorable “grandfathering” treatment of the old policy under the federal tax code? Will the existing insurer be willing to modify the old policy? How does the quality and financial stability of the new company compare with your existing company?

American Century Life Insurance Company of Texas (a stipulated premium company)

1333 W. McDermott Dr., Suite 150 Allen, TX 75013

Phone (855) 966-1111, Fax (855) 855-0181

IRA Required Minimum Distribution RequestUse this form to request a withdrawal from your individual retirement annuity (IRA) to satisfy your IRS Required Minimum Distribution (RMD). If you have any questions regarding your RMD, please consult with your personal tax advisor.

Policy #: Annuitant: Owner:

SECTION 1 – ELECTION OF REQUIRED MINIMUM DISTRIBUTION (RMD)

I do not want American Century Life Insurance Company of Texas to calculate and distribute my RMD payment. I will take my RMD from another IRA for all years until I notify you in writing.

I elect an automatic RMD distribution to be made: Annually Semi Annually Quarterly Monthly, beginning the month of and

continuing until I notify you in writing to terminate the distributions.

Is your beneficiary your spouse? Yes No If YES, and he/she is more than 10 years younger than you, please provide his/her date of birth: _________________

SECTION 2 – DISTRIBUTION METHOD Indicate below how you wish to receive your Automatic RMD payment

Option A: By Check. Checks will be made payable to the policy owner and mailed to the address on record. Option B: Automatic deposit into my account shown below by Electronic Funds Transfer (EFT).

Bank Name: Account Type: Checking Savings

Account Number: Routing Number:

SECTION 3 – ELECTION FOR WITHHOLDING I certify that I have not assigned or pledged the above certificate for any purpose whatsoever, and that no bankruptcy proceedings are pending against me. Please check only one of the boxes below.

I elect not to have Federal income tax withheld from the taxable portion of the distribution. I elect to have ______% Federal income tax withheld from the taxable portion of the distribution. (Cannot

be less than 10%)

I hereby accept the elections made above and agree with the terms of this form and its instructions. I acknowledge that American Century Life Insurance Company of Texas employees, agents or representatives do not give tax, legal or accounting advice. I agree to consult with my own attorney, accountant or professional tax advisor for details relating to my specific situation. I understand that I am responsible for calculating and withdrawing my Required Minimum Distributions, including all tax liability and other possible consequences which may be involved. I acknowledge that American Century Life Insurance Company of Texas is not responsible and I agree to indemnify and to hold American Century Life Insurance Company of Texas harmless from any resulting liabilities

PLEASE SIGN BELOW

Owner Signature Social Security No. Date

I hereby agree to the above cash surrender and waive any community property or Uniform Marital Property Act (UMPA) rights, as applicable, that I may have in the subject of this cash surrender. If the spousal consent is not signed, the above signature is certification that no spousal consent is required.

Signature of spouse of policyowner: Date:

RMD (11-17)

American Century Life Insurance Company of Texas (a stipulated premium company)

1333 W. McDermott Dr., Suite 150 Allen, TX 75013

Phone (855) 966-1111, Fax (855) 855-0181

Prohibited Transaction Exemption 84-24 Disclosure Statement This disclosure is being made to satisfy the requirements and conditions of the U.S. Department of Labor Prohibited Transaction Exemption 84-24. This disclosure provides important information for you to consider in determining whether to purchase the recommended annuity contract with IRA or other assets subject to Title I of ERISA

Product:

Impartial Conduct Standards At the time of the recommendation the advice given to you by the producer is believed to be in your “best interest”. This means the advice reflects the care, skill, prudence, and diligence under the circumstances prevailing that a prudent person acting in a like capacity and familiar with such matters would use in the conduct of an enterprise of a like character and with like aims, based on your risk tolerance, investment objectives, financial circumstances, and needs without regard to the financial or other interest of the producer.

Fees and Charges Any charges or fees which may be imposed under the recommended contract, including any surrender charges or rider fees, in connection with the purchase, holding, exchange, termination, or sale have been disclosed to you in the form of product brochures or other materials produced by the Insurance company issuing the contract or the producer recommending the product.

Compensation The producer will receive from the Insurance Company the following commissions, and in some cases, other compensation including reimbursement for travel, training, meals, entertainment and attendance at insurance company conferences. The commissions and any other compensation are paid by the insurance company and your entire premium will be credited to your accumulation value upon issue of your annuity contract. ______% of the_____________ for the first guaranteed period of the Contract which includes commissions, bonuses and any other form of compensation; ______% of the_____________ paid at the time of renewal if you elect another guaranteed period. Additional incentives, if any, received by the producer from any third parties for your purchase of this annuity contract: _____________________

Affiliations and Limitations The producer or representative is licensed in the state this annuity is being recommended in and is appointed by the insurance company to sell you this annuity. The producer or representative is not limited by any agreement with the insurance company to recommend any annuity or insurance contract.

Material Conflicts of Interest The producer has a financial interest in the transaction being recommended, which could affect his or her best judgment as a fiduciary when recommending this product to you. Potential material conflicts of interest the producer may experience in providing investment advice to you are:

• Receipt of Commission • Rollover Recommendations• Receipt of other Incentives • Product Recommendations

Acknowledgment of Disclosure and Approval of Transaction

Producer Acknowledgment

Client Name (Print) Producer Name (Print)

Client Signature Producer Signature

Date Date

PTE 84-24 (11-17)

American Century Life Insurance Company of Texas 1333 W. McDermott Dr., Suite 150

Allen, TX 75013 Phone (855) 966-1111

Fax (855) 855-0181

Producer Acknowledgment - PTE 84-24

Client’s Name: Client’s SSN:

As a producer contracted with American Century Life Insurance Company of Texas, I understand I am a fiduciary, and that I shall comply with the requirements of the U.S. Department of Labor Fiduciary Rule Prohibited Transaction Exemption 84-24 (“PTE 84-24”) in order to receive commissions on qualified fixed annuity business. Accordingly, I acknowledge the following for this transaction:

American Century Life Insurance Company of Texas is not a fiduciary, or acting as a financial institution.

I am compliant with PTE 84-24, as applicable, including the following:

I have acted in the “Best Interest”, within the meaning of PTE 84-24, of the client in making this recommendation.

I have not made any misleading statements to the client.

I have disclosed any material conflicts of interest to the client.

I have disclosed my commission, including other forms of compensation, to be received from this transaction to the client.

I have provided to the client a description of all charges associated with the annuity contract, including surrender charges and rider fees.

I have received the client’s written acknowledgment of receipt of the required disclosures using a form that is substantially similar to the sample provided by American Century Life Insurance Company of Texas.

I will retain the required documentation of this transaction for at least six years

Producer Signature:

Producer Name:

Producer Number:

Date:

PTE 84-24 (11-17)