Service Forms
Internal Exchange Statement and Agreement for Annuity Contract
For transferring assets internally from one Security Benefit Contract type to another Security Benefit product. For example, transfer assets from your 403(b) TSA to your 401(k) Account. Please read Transfer Procedures carefully.
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DownloadBy Mail
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.
Investment Advisor Authorization Clearline & EliteDesigns
Use this form to establish authority of your investment advisor.
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Please print or type.
DownloadBy MailSecurity 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.
Limited Power of Attorney for Annuity Contract
This form gives the authority set forth in section 3 to another person ("attorney in fact") to act on your behalf for the Contract/Account Number identified below.
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DownloadBy Mail
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.
Loan Application, Agreement and Promissory Note for Annuity Contract
Use this form to establish a loan on your account.
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Complete all fields. Please type or print.
DownloadBy MailSecurity 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.
Non-Financial Change for Annuity Contract
For changing the name and/or address of the existing Annuitant/Participant, Beneficiary(ies), Owner, or Joint Owner of the Contract.
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DownloadBy Mail
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.
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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DownloadBy Mail
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.
Proof of Death for Annuity Contract
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.
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DownloadBy Mail
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.
Required Minimum Distribution (RMD) for Annuity Contract
The Internal Revenue Service ("IRS") requires individuals to begin receiving a Required Minimum Distribution ("RMD") from qualified accounts(s) at 73. Upon attaining this age, it is your responsibility to request these distributions.
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Restricted Beneficiary Designation for Annuity Contract
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.
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Complete all information within each of the applicable sections. If incomplete, the form may be returned.
• Section 1 – You must complete the entire General Account Information section.
• Sections 2 and 3 – These sections allow you to designate up to two Primary Beneficiaries.
• Sections 4 and 5 – These sections allow you to designate up to two Contingent Beneficiaries.
• Section 6 – You must obtain all required signatures:
– All Owners must sign the request.
– If you are married and live in a Community Property State, your spouse must sign if he/she is not the primary beneficiary.
– If the Owner is a Trust, the trustee(s) must sign the request.DownloadBy MailSecurity 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.
Salary Reduction Agreement for Annuity Contract
Use this form to set up or change contributions to your account from your paycheck.
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Please type or print.
Please check with your employer to verify that this agreement meets your employer’s requirements. You must complete sections 1, 5 and any of the following that apply:
- Section 2 for 401(k)
- Section 3 for 403(b)
- Section 4 for 457
DownloadBy MailSecurity 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.