Service Forms
Loan Application and Agreement for NEA Valuebuilder® Future, Select and Multi-Flex
For applying for a loan, selecting your repayment frequency, applying to make payments electronically via Electronic Funds Transfer (EFT), or selecting your Loan Disbursement Method.
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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.
Loan Application, Agreement and Promissory Note for Annuity Contract
Use this form to establish a loan on your account.
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Complete all fields. Please type or print.
DownloadBy MailSecurity 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.
Loan Application, Agreement and Promissory Note for Custodial Account
Use this form to establish a loan on your retirement account.
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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
Medical/Dependent Care Reimbursement Program Claim for Security Flex 125 Program®
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Use this form to request medical expense or dependent care reimbursement.
DownloadBy MailSecurity Flex 125
P.O. Box 75066
Topeka, KS 66675
United StatesOvernight DeliverySecurity Benefit
Mail Zone 600
One Security Benefit Place
Topeka, KS 66636
United StatesBy FaxYou may also email your form to [email protected]
Non-Financial Change for Annuity Contract
For changing the name and/or address of the existing Annuitant/Participant, Beneficiary(ies), Owner, or Joint Owner of the 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.
Non-Financial Change for Custodial Account
For changing the name and/or address of the existing Annuitant/Participant, Beneficiary(ies), Owner, or Joint Owner of the Contract.
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Please type or print in black ink. Complete all necessary fields and signatures.
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.
Non-Financial Change for Group Healthcare Reimbursement (HRA)
For changing the name and/or address of the existing participant or IRS eligible dependent.
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Please type or print in black ink. Complete all necessary fields and signatures.
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.
Non-Resident Information for Annuity Contract
Use this form whenever an applicant applies for an annuity in a state that is not his/her resident state.
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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.
Outgoing Fund Transfer Request for NEA Valuebuilder® Future, Select and Multi-Flex: 1035 EXCHANGE / ROLLOVER / TRANSFER eFORM
Use this form to transfer funds from Security Benefit to a new carrier.
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Outgoing Fund Transfer Request for Annuity Contract
Use this form to transfer funds from Security Benefit to a new carrier.
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