Select Benefit Annuity


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




Account Value Reallocation 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.


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.

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.

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.

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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