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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)



NEA Valuebuilder® Select, Future and Multi-Flex TSA


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


Form Description
Annuitization Election of Option For annuitizing your contract, designating Annuity Life and Non-Life options and Secondary Payee information. Select your investment basis, method and frequency of the payout, and tax withholding information.
Asset Reallocation/Dollar Cost Averaging

Asset Reallocation - Allows you to automatically transfer funds monthly, quarterly, semi-annually, or annually to maintain a specific percent allocation among your investment options.

Dollar Cost Averaging - Allows you to periodically exchange contract value from one investment option to one or more other options. You may select the option by which you would like funds transferred as well as select the transfer to occur monthly, quarterly, semi-annually or annually.

Authorization for Automatic Deposits For establishing the privilege to have payments made from your Security Benefit Contract directly to your Bank Account. This form works similar to the Electronic Funds Transfer form, it enables you to transfer funds electronically.
Automatic Bank Draft For making electronic investments directly from your bank account to Security Benefit. Within in the form, you may select the amount you would like automatically invested and the frequency of the investments.
Contribution Information For changing the contribution amount of future payments, changing employer information and applying to make contributions automatically via Electronic Funds Transfer (EFT). Note: This is not the proper form to use to transfer funds. For this activity, please see our Request for Transfer of Assets form.
Electronic Transfer Authorization For establishing the privilege to make changes to your contract via telephone. With this option you can submit an exchange between funds and change your future allocations.
Investment Fund List The investment line-up for the NEA Valuebuilder Multi-Flex Annuity and the NEA Valuebuilder Select and Future Annuity.
Incoming Funds Transfer For transferring assets from your Current Carrier to a Security Benefit Annuity Contract.

Internal Exchange Statement and Agreement

Use this form to transfer funds internally from one account to another. (This includes transferring assets from one employer
plan to another employer plan).

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.
Loan Application and Agreement 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. Please read the most commonly asked questions on the last two pages of the form. Note: The loan amount available to you is dependent on your contract value.
Registration Change 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).
Salary Reduction Agreement For the purchase of a 403(b) Annuity Contract (through Salary Reduction) to provide retirement benefits for the employee.
Scheduled Systematic Withdrawal For adding or changing Scheduled Systematic Withdrawal options, please contact your Advisor or our Service Center (800.888.2461) to request a form.
Transfer of Assets For transferring funds from one account to another, completing a one-time Asset Re-balance, changing the allocation of future payments (Change of Future Allocation), or applying for Telephone Exchange Authorization, which allows you to exchange fund shares over the phone.
Withdrawal Charge Waiver For establishing privileges to withdraw funds from your contract without incurring a surrender penalty. Must meet requirements outlined on the form. This form must accompany any withdrawal form requested under the Hospital/Nursing Home, Disability or Terminal Illness Waiver Option.

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