1035 EXCHANGE / ROLLOVER / TRANSFER eFORM
This form can be used to accomplish a FULL or a PARTIAL Exchange of policies pursuant to Internal Revenue Code (IRC) Section 1035.
Complete the entire form. Please type or print.
- Complete this form and any applicable state-required replacement forms.
- Please contact the current carrier for any requirements it may have for transferring money to another company.
- Upon receiving this material Security Benefit will send an acceptance letter to the carrier.
- If you are completing this form for a 403(b) or 403(b)(7) account/contract please contact your employer for any processing instructions the employer or third party administrator may require.
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.