Variable Annuity | Fixed Annuity | Fixed Index Annuity

Outgoing Funds Request for Annuity Contracts

Use this form to transfer funds from Security Benefit to a new carrier.

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Fixed Annuity | Fixed Index Annuity | Variable Annuity

Scheduled Systematic Withdrawal Request for Annuity Contract

Use this form to establish a Scheduled Systematic Withdrawal (SSW) from fixed annuities, fixed index annuities, and variable annuities (excludes Mutual of Omaha or NEA).

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Mutual Fund | Variable Annuity | Other

Required Minimum Distribution (RMD) for Custodial Account

The Internal Revenue Service (IRS) requires individuals to begin receiving a Required Minimum Distribution (RMD) from qualified accounts(s) at 70½. Upon attaining this age, it is your responsibility to request these distributions.

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Mutual Fund | Variable Annuity | Other

Scheduled Systematic Withdrawal Request for Custodial Account

Use this form to establish a Scheduled Systematic Withdrawal (SSW) mutual fund group retirement accounts.

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Mutual Fund | Variable Annuity | Other

Withdrawal Request for Custodial Account

Use this form to make a one-time withdrawal from mutual fund group retirement accounts (excludes Mutual of Omaha or NEA).

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Variable Annuity

Incoming Funds Request for SecureDesigns® Variable Annuity

Use this form to transfer funds from your current carrier to Security Benefit.

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Complete the entire form. Please type or print.

  1. The Owner should complete this Incoming Funds Request form and any applicable state-required replacement forms.
  2. Please contact your current carrier for any requirements it may have for transferring money to another company.
  3. Obtain Signature Guarantee if required by your current carrier.
  4. Upon receiving this material Security Benefit will send an acceptance letter to the carrier.
  5. If you are completing this form for a 403(b) or 403(b)(7) account/contract please contact your employer for any processing instructions the employer or third party administrator may require.
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
Download
For questions or assistance, please call 800.888.2461.
Mutual Fund | Variable Annuity

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 agreementdirectly 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.

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
Download
For questions or assistance, please call 800.747.3942
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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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
Download
For questions or assistance, please call 800.888.2461.
Variable Annuity

Investment Advisor Authorization for Annuity Contract

Use this form to establish authority for your investment advisor.

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Complete the entire form. Please type or print.

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
Download
For questions or assistance, please call 800.888.2461.
Mutual Fund | Variable Annuity | Other

Proof of Death for Custodial Account

This form is to be completed in order to claim proceeds payable upon death. A separate Proof of Death form should be completed and signed by each beneficiary.

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Please type or print in black ink. A separate Proof of Death form should be completed and signed by each beneficiary.

Although the Company reserves the right to require or obtain further information, the following is required:

  1. Proof of Death Form
     
  2. Death Certificate
     
  3. Consular Report of Death of a U.S. Citizen Abroad (if the deceased died in a foreign country)
     
  4. Notice of Name Change
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
Download
For questions or assistance, please call 800.747.3942