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.
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 Mail
P.O. Box 750497
Topeka, KS 66675-0497
United StatesOvernight Delivery
Mail Zone 497
One Security Benefit Place
Topeka, KS 66636-0001
United StatesBy FaxFor questions or assistance, please call 800.888.2461.