Most Requested Forms


Select links to download forms (PDFs).


Loan Application, Agreement and Promissory Note: Use this form to establish a loan on your retirement account for group retirement products.


Loan Application, Agreement and Promissory Note (Group Retirement Products Only)


Loan Application, Agreement and Promissory Note (Fixed Annuities, Fixed Indexed Annuities, Variable Annuities)


Non-Financial Change: Modify or change information regarding: Owner, Joint Owner, Annuitant, Beneficiary and/or address change.


Non-Financial Change (Group Retirement Products Only)


Non-Financial Change (Fixed Annuities, Fixed Indexed Annuities, Variable Annuities)



Lighthouse Select Annuity


For help on filling out the forms, please view the instructions.


Service Forms



Please type or print. Use this form to begin annuity payments. Complete each section of the form. If the applicant selects a life annuity option in Section 2, he/she must also provide proof of age, such as: Birth Certificate, School or College Record, Passport, Naturalization Papers, Military Record.

Electronic Authorization

Use this form to activate electronic services. Transactions may be requested via telephone, Internet, or other electronic means by the contract owner and/or servicing sales representative based on instructions of the owner. Authorization must be on file with Security Benefit before we will activate electronic services.

Electronic Bank Information

Use this form to activate or update electronic banking. Complete the entire form and please note the following:

Electronic Bank Deposit - Funds can be sent from the contract owner's Security Benefit account to his/her bank account and arrive within 3 business days after the withdrawal.

Electronic Bank Withdrawals - Funds can only be drafted from the contract owner's bank account to be deposited as a contribution into a Roth IRA, Traditional IRA or other non-qualified account types. Deposits to the contract owner's Security Benefit account will be allocated according to the future allocations on file.

Minimum subsequent purchase payment amount is $1,000 per additional purchase.

Incoming Funds Request

Use this form to transfer funds from the contract owner's carrier to Security Benefit.

Non-Financial Change

Use this form to modify or change information regarding the roles on in the contract owner's account, such as Name, Address, Beneficiary, etc.

One-Time Withdrawal

To make a one-time withdrawal from your account, please contact your Advisor or our Service Center (800.888.2461) to request a form.

Proof of Death

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.

Reallocation of Assets

This form is used to select a new guarantee period for investments that have reached the end of the withdrawal charge period. The form details the reallocations options available.

Restricted Beneficiary Designation

This form should be used if you wish to place restrictions on the payout of your death benefit to your beneficiaries. This Beneficiary Designation supersedes any and all previous Beneficiary designations. Security Benefit suggests that you keep a copy of this form.

Required Minimum Distribution

To add or change Required Minimum Distribution options, contact your Advisor or our Service Center (800.888.2461) to request a form.

Scheduled Systematic Withdrawal

To add or change Scheduled Systematic Withdrawal options, contact your Advisor or our Service Center (800.888.2461) to request a form.

Trust or Entity Certification

This Trust or Entity Certification Form must be used when a partnership, trust, or other non-natural person(collectively "Entity"), is the owner of the annuity contract. This form identifies individuals who are authorized to conduct transactions in, and exercise ownership rights with respect to, the Contract on behalf of an Entity.


These forms are formatted in Adobe Acrobat. To view and print these forms, you will need the Adobe Acrobat "plug-in" for your browser. You may experience difficulties if you do not have the latest version installed on your computer. The Icon below will take you to the Adobe Acrobat site where you can download the "plug-in" free of charge.

Get Acrobat