Service Forms

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 agreementdirectly 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.

Please type or print in black ink. A separate Proof of Death form should be completed and signed by each beneficiary.

Although the Company reserves the right to require or obtain further information, the following is required:

1. Proof of Death Form
    
2. Death Certificate
    
3. Consular Report of Death of a U.S. Citizen Abroad (if the deceased died in a foreign country)
    
4. Notice of Name Change