Service Forms
Investment Fund List for NEA Valuebuilder® Future and Select Annuities
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Security Benefit
P.O. Box 750497
Topeka, KS 66675-0497
United StatesOvernight DeliverySecurity Benefit
Mail Zone 497
One Security Benefit Place
Topeka, KS 66636-0001
United StatesBy FaxFor questions or assistance, please call 800.888.2461.
Investment Fund List for NEA Valuebuilder® Multi-Flex
The investment line-up for the NEA Valuebuilder Multi-Flex Annuity.
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DownloadBy Mail
Security Benefit
P.O. Box 750497
Topeka, KS 66675-0497
United StatesOvernight DeliverySecurity Benefit
Mail Zone 497
One Security Benefit Place
Topeka, KS 66636-0001
United StatesBy FaxFor questions or assistance, please call 800.888.2461.
Investment Fund List SecurePoint Retirement
In completing your application or investment request, please clearly write the fund name listed below in the appropriate sections of each form.
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Please print or type.
DownloadBy MailSecurity Benefit Retirement Plan Services
PO Box 219141
Kansas City, MO 64121-9141
United StatesOvernight DeliverySecurity Benefit Retirement Plan Services
430 W 7th Street STE 219141
Kansas City, MO 64105-1407
United StatesBy FaxQuestions? Please call our National Service Center at 800.747.3942.
Large Case Review Questions
Use this form for cases over a million dollars.
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DownloadBy Mail
Security Benefit
P.O. Box 750497
Topeka, KS 66675-0497
United StatesOvernight DeliverySecurity Benefit
Mail Zone 497
One Security Benefit Place
Topeka, KS 66636-0001
United StatesBy FaxFor questions or assistance, please call 800.888.2461.
Letter of Medical Necessity for Security Flex 125 Program®
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DownloadBy Mail
Security Benefit
Retirement Plan Services
P.O. Box 750600
Topeka, KS 66675-0600
United StatesOvernight DeliverySecurity Benefit
Mail Zone 560
One Security Benefit Place
Topeka, KS 66636-0001
United StatesBy FaxQuestions? Please call our National Service Center at 1.800.888.2461
Life Withdrawal Request for Mutual of Omaha/United of Omaha
Use this form to make a one-time withdrawal for the Mutual of Omaha Life Insurance product.
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Lifetime Income Election for Annuity Contract
The contract owner must complete the applicable sections of this form to begin receiving payments under the Income Rider of his/her contract.
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DownloadBy Mail
Security Benefit
P.O. Box 750497
Topeka, KS 66675-0497
United StatesOvernight DeliverySecurity Benefit
Mail Zone 497
One Security Benefit Place
Topeka, KS 66636-0001
United StatesBy FaxFor questions or assistance, please call 800.888.2461.
Limited Power of Attorney for Annuity Contract
This form gives the authority set forth in section 3 to another person ("attorney in fact") to act on your behalf for the Contract/Account Number identified below.
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DownloadBy Mail
Security Benefit
P.O. Box 750497
Topeka, KS 66675-0497
United StatesOvernight DeliverySecurity Benefit
Mail Zone 497
One Security Benefit Place
Topeka, KS 66636-0001
United StatesBy FaxFor questions or assistance, please call 800.888.2461.
Limited Power of Attorney for Custodial Account
This form gives authority to another person (“attorney in fact”) to act on your behalf for the Account Number identified This authorization must be on file with Security Benefit before we will activate this authority.
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Please type or print in black ink. Complete all required fields.
DownloadBy MailSecurity Benefit Retirement Plan Services
PO Box 219141
Kansas City, MO 64121-9141
United StatesOvernight DeliverySecurity Benefit Retirement Plan Services
430 W 7th Street STE 219141
Kansas City, MO 64105-1407
United StatesBy FaxQuestions? Please call our National Service Center at 800.747.3942.
Loan Application Agreement and Promissory Note for Custodial Account
Use this form to establish a loan. Please complete the entire form. This transaction will be processed as of the valuation date
Security Benefit receives all required paperwork.
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Complete all fields. Please type or print.
To apply for a loan:
- 401(a), 401(k), 403(b)(7) ERISA Plans – Submit completed loan application and agreement to your Plan Sponsor for their signature.
- 401(a) Governmental, 403(b)(7) Voluntary, 457 Governmental Plans – Submit completed loan application and agreement directly to Security Benefit.
To receive additional information, you may contact your Financial Representative, call our Service Center at 1-800-747-3942 or visit our
website at www.securityretirement.com.DownloadBy MailSecurity Benefit Retirement Plan Services
PO Box 219141
Kansas City, MO 64121-9141
United StatesOvernight DeliverySecurity Benefit Retirement Plan Services
430 W 7th Street STE 219141
Kansas City, MO 64105-1407
United StatesBy FaxQuestions? Please call our National Service Center at 800.747.3942.