Employer Data Request for Custodial Account

Mutual Fund

Employer Data Request for Custodial Account

Use this form to authorize Security Benefit Corporation, or its subsidiaries (“Security Benefit”), to initiate periodic electronic transactions to/from the Employer’s bank account as indicated on this form, to reflect the Employer’s Plan contribution liabilities for each payroll period, determined in accordance with the terms of the Plan and applicable employee deferral elections.

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Instructions

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By Mail

Security Benefit Retirement Plan Services
PO Box 219141
Kansas City, MO 64121-9141
United States

Overnight Delivery

Security Benefit Retirement Plan Services
430 W 7th Street STE 219141
Kansas City, MO 64105-1407
United States

By Fax
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Questions? Please call our National Service Center at 800.747.3942.