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Most Requested Forms


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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)



Secure Income Annuity


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


Form Description
Account Value Transfer Request Please complete all sections. Use this form to allocate Account Value among the Fixed Account and Index Accounts. To make changes to the contract owner's allocations, this form must be received within 21 days after his/her Contract Anniversary date for the changes to take effect.
Annuitization 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.
Annuity Comparison Complete one Annuity Comparison form for each annuity being replaced. Please complete all information. If a category does not apply, please mark as N/A. Any incomplete forms will be returned. All information should match the information provided on the Annuity Suitability form. Any item that does not match may require additional information from the applicant or may cause the application to be returned. This form must be completed with the original sent to Security Benefit, a copy provided to the applicant and a copy kept by the agent.
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.
Financial Inventory This form is not required to be submitted with an application. Should additional information about the suitability of this product be needed, Security Benefit will request this form (or a similar form that covers the same information) be submitted. All sections are required to be completed. Approximate, not exact, values are sufficient. The financial information of the joint applicant should be included in the responses. If the applicant's spouse or partner is a member of the same household, and is not the joint applicant, the spouse or partner's information should be included in the responses. All information will be treated with the highest degree of confidentiality and will not be used for any other purpose than to assess the suitability of this product.
Home Healthcare Doubler Request This form must accompany any request for the Home Healthcare Doubler and be fully completed and signed by both the owner and authorized physician.
Hierarchy Information Complete the hierarchy information for each agent contracting with Security Benefit Life Insurance Company (SBL). This sheet must accompany all new contracting agreements. List all hierarchy levels including the agent/agency.
Incoming Funds Transfer Use this form to transfer funds from the contract owner's carrier to Security Benefit.

Internal Exchange Statement Agreement

Use this form to transfer funds internally from one account to another.
Lifetime Income Election The contract owner must complete the applicable sections of this form to begin receiving payments under the Income Rider of his/her contract.
Non-Financial Change Use this form to modify or change information regarding the roles on in the contract owner's account.
Non-Resident Information Use this form whenever an applicant applies for an annuity in a state that is not his/her resident state
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.
Restricted Beneficiary Designation This form should be used if the contract owner wishes to place restrictions on the payout of his/her death benefit to designated beneficiaries. This Beneficiary Designation supersedes any and all previous Beneficiary designations. Security Benefit suggests that the owner 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.


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