Financial Inventory for Annuity Contract

This form is not required to be submitted with an Application. Should additional information about the suitability of this product be needed, Security Benefit will request this form (or a similar form that covers the same information) be submitted. All sections are required to be completed. Approximate, not exact, values are sufficient. The financial information of the joint applicant should be included in the responses. If the Applicant’s spouse or partner is a member of the same household, and is not the joint applicant, the spouse or partner’s information should be included in the responses.

Note: All information will be treated with the highest degree of confidentiality and will not be used for any other purpose than to assess the suitability of this product.