Salary Reduction Agreement for Annuity Contract

Variable Annuity | Mutual Fund

Salary Reduction Agreement for Annuity Contract

Use this form to set up or change contributions to your account from your paycheck.

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Instructions

Please type or print.

Please check with your employer to verify that this agreement meets your employer’s requirements. You must complete sections 1, 5 and any of the following that apply:

Section 2 for 401(k)
Section 3 for 403(b)
Section 4 for 457

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.