Service Forms
Asset Reallocation for Custodial Account
Use this form to automatically transfer account values to maintain a specific percentage allocation among your current and future investment options.
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Security 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.
Dollar Cost Averaging for Custodial Account
Use this form to request periodic exchanges from one investment option to one or more investment options.
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Security 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.
Employer Data Request for Custodial Account
Use this form to authorize Security Benefit Corporation, or its subsidiaries (“Security Benefit”), to initiate periodic electronic transactions to/from the Employer’s bank account as indicated on this form, to reflect the Employer’s Plan cont
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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.
Incoming Funds Request SecurePoint Retirement
Use this form to transfer funds from your current carrier to Security Benefit. Complete the entire form.
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Please print or type.
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.
Investment Fund List SecurePoint Retirement
In completing your application or investment request, please clearly write the fund name listed below in the appropriate sections of each form.
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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.
Limited Power of Attorney for Custodial Account
This form gives authority to another person (“attorney in fact”) to act on your behalf for the Account Number identified This authorization must be on file with Security Benefit before we will activate this authority.
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Please type or print in black ink. Complete all required fields.
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.
Loan Application Agreement and Promissory Note for Custodial Account
Use this form to establish a loan. Please complete the entire form. This transaction will be processed as of the valuation date
Security Benefit receives all required paperwork.
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Complete all fields. Please type or print.
To apply for a loan:
- 401(a), 401(k), 403(b)(7) ERISA Plans – Submit completed loan application and agreement to your Plan Sponsor for their signature.
- 401(a) Governmental, 403(b)(7) Voluntary, 457 Governmental Plans – Submit completed loan application and agreement directly to Security Benefit.
To receive additional information, you may contact your Financial Representative, call our Service Center at 1-800-747-3942 or visit our
website at www.securityretirement.com.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 Funds Request for Custodial Account
Use this form to transfer funds from your Security Benefit account to a new carrier.
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Per Stirpes Designation
This form is to be completed when an applicant wishes to identify a beneficiary with a per stirpes designation.
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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.
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.
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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.