Service Forms
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.
- Download
-
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.
- Download
-
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.
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.
- Download
You must sign in to access this content. Please sign in with your username and password.
Sign In
Outgoing Funds Request for Annuity Contracts - 1035 EXCHANGE / ROLLOVER / TRANSFER eFORM
Use this form to transfer funds from Security Benefit to a new carrier.
- Download
You must sign in to access this content. Please sign in with your username and password.
Sign In
Outgoing Funds Request for Custodial Account
Use this form to transfer funds from your Security Benefit account to a new carrier.
- Download
You must sign in to access this content. Please sign in with your username and password.
Sign In
Outgoing Funds Request for Mutual of Omaha/United of Omaha
Use this form to transfer funds from Security Benefit to a new carrier.
- Download
You must sign in to access this content. Please sign in with your username and password.
Sign In
Plan Sponsor Non-Financial Change Form for Custodial Account
This form allows you to use Security Benefit’s secure plan sponsor website to access plan and plan participant related information and perform online tasks.
- Download
-
Complete the entire form. Please type or print.
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.
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.
- Download
-
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:
- Proof of Death Form
- Death Certificate
- Consular Report of Death of a U.S. Citizen Abroad (if the deceased died in a foreign country)
- Notice of Name Change
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. - Proof of Death Form
Registration Change for NEA Valuebuilder® Future, Select and Multi-Flex
For changing the name and/or address of the existing Annuitant/Participant, Owner of the Contract or changing the primary and/or contingent beneficiary(ies).
- Download
-
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.
Reimbursable Over-the-Counter Medications & Program Updates for Security Flex 125 Program®
- Download
-
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