1035 EXCHANGE / ROLLOVER / TRANSFER eFORM

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1035 EXCHANGE / ROLLOVER / TRANSFER eFORM

This form can be used to accomplish a FULL or a PARTIAL Exchange of policies pursuant to Internal Revenue Code (IRC) Section 1035. This form can also be used for Transfers of Funds and Direct Rollovers.

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Instructions

Complete the entire form. Please type or print.

  1. Complete this form and any applicable state-required replacement forms.
  2. Please contact the current carrier for any requirements it may have for transferring money to another company.
  3. Upon receiving this material Security Benefit will send an acceptance letter to the carrier.
  4. If you are completing this form for a 403(b) or 403(b)(7) account/contract please contact your employer for any processing instructions the employer or third party administrator may require.
By Mail

Security Benefit
P.O. Box 750497
Topeka, KS 66675-0497
United States

Overnight Delivery

Security Benefit
Mail Zone 497
One Security Benefit Place
Topeka, KS 66636-0001
United States

By Fax
785.368.1772
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For questions or assistance, please call 800.888.2461.