Service Forms

Below are the forms and related documents you or your clients may need for in-force Secure Income Annuity contracts and the optional Guaranteed Lifetime Withdrawal Benefit (GLWB) Rider.

Service Forms Description
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.
Account Value Transfer Request Please complete all sections. Use this form to allocate Account Value among the Fixed Account and Index Accounts. To make changes to the contract owner's allocations, this form must be received within 21 days after his/her Contract Anniversary date for the changes to take effect.
Annuitization Please type or print. Use this form to begin annuity payments. Complete each section of the form. If the applicant selects a life annuity option in Section 2, he/she must also provide proof of age, such as: Birth Certificate, School or College Record, Passport, Naturalization Papers, Military Record.
Annuity Comparison Complete one Annuity Comparison form for each annuity being replaced. Please complete all information. If a category does not apply, please mark as N/A. Any incomplete forms will be returned. All information should match the information provided on the Annuity Suitability form. Any item that does not match may require additional information from the applicant or may cause the application to be returned. This form must be completed with the original sent to Security Benefit, a copy provided to the applicant and a copy kept by the agent.
Electronic Authorization Use this form to activate electronic services. Transactions may be requested via telephone, Internet, or other electronic means by the contract owner and/or servicing sales representative based on instructions of the owner. Authorization must be on file with Security Benefit before we will activate electronic services.
Electronic Bank Information

Use this form to activate or update electronic banking. Complete the entire form and please note the following:

  • Electronic Bank Deposit - Funds can be sent from the contract owner's Security Benefit account to his/her bank account and arrive within 3 business days after the withdrawal.
  • Electronic Bank Withdrawals - Funds can only be drafted from the contract owner's bank account to be deposited as a contribution into a Roth IRA, Traditional IRA or other non-qualified account types. Deposits to the contract owner's Security Benefit account will be allocated according to the future allocations on file.
  • Minimum subsequent purchase payment amount is $1,000 per additional purchase.
Financial Inventory This form is not required to be submitted with an application. Should additional information about the suitability of this product be needed, Security Benefit will request this form (or a similar form that covers the same information) be submitted. All sections are required to be completed. Approximate, not exact, values are sufficient. The financial information of the joint applicant should be included in the responses. If the applicant's spouse or partner is a member of the same household, and is not the joint applicant, the spouse or partner's information should be included in the responses. All information will be treated with the highest degree of confidentiality and will not be used for any other purpose than to assess the suitability of this product.
Home Healthcare Doubler Request This form must accompany any request for the Home Healthcare Doubler and be fully completed and signed by both the owner and authorized physician.
Hierarchy Information Complete the hierarchy information for each agent contracting with Security Benefit Life Insurance Company (SBL). This sheet must accompany all new contracting agreements. List all hierarchy levels including the agent/agency.
Internal Exchange Statement Agreement Use this form to transfer funds internally from one account to another.
Large Case Review Form Use this form for cases over a million dollars.
Lifetime Income Election The contract owner must complete the applicable sections of this form to begin receiving payments under the Income Rider of his/her contract.
Non-Financial Change Use this form to modify or change information regarding the roles on in the contract owner's account, such as Name, Address, Beneficiary, etc.
Non-Resident Information Use this form whenever an applicant applies for an annuity in a state that is not his/her resident state.
Notification of Divorce and Transfer Request Use this form to facilitate the transfer of assets or change ownership of a Security Benefit Life Insurance Company (“Security Benefit”) annuity to any person who is designated to receive a share of the contract value, most often the former spouse (the “Alternate Payee” or a Joint Owner) as a result of divorce or legal separation proceedings.
Proof of Death 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.
Proposed Contract Review This form allows a preliminary review for suitability and in no way eliminates the required suitability paperwork.
Surrender Charge Waiver For establishing privileges to withdraw funds from your contract without incurring a surrender charge penalty, such as for Nursing Home stay or a Terminal Illness diagnosis. Must meet requirements outlined on the form and in your contract.
Trust or Entity Certification This Trust or Entity Certification form must be used when a partnership, trust, or other non-natural person (collectively "Entity"), is the owner of the annuity contract. This form identifies individuals who are authorized to conduct transactions in, and exercise ownership rights with respect to, the Contract on behalf of an Entity.
Withdrawal and Distribution Forms Withdrawal and Distribution forms are only available to who are logged into the website. 

IM-50001-30 | 2023-05-16