Service Forms

Complete the entire form. Please type or print.

1. Complete this form and any applicable state-required replacement forms.
2. Please contact the current carrier for any requirements it may have for transferring money to another company.
3. Upon receiving this material Security Benefit will send an acceptance letter to the carrier.
4. 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.

If you would like to make changes to your allocations, this form must be received within 10 days after your Contract Anniversary date for the changes to take effect. Please type or print.

Complete the entire form. Please type or print.

1. The Owner should complete this Incoming Funds Request form and any applicable state-required replacement forms.
2. Please contact your current carrier for any requirements it may have for transferring money to another company.
3. Obtain Signature Guarantee if required by your current carrier.
4. Upon receiving this material Security Benefit will send an acceptance letter to the carrier.

Complete the entire form. Please type or print.

1. The Owner should complete this Incoming Funds Request form and any applicable state-required replacement forms.
2. Please contact your current carrier for any requirements it may have for transferring money to another company.
3. Obtain Signature Guarantee if required by your current carrier.
4. Upon receiving this material Security Benefit will send an acceptance letter to the carrier.

• Please complete all sections. Use this form to reallocate Account Value among the Fixed Account and Index Accounts.
   
• If you would like to make changes to your allocations, this form must be received within 21 days after your Contract Anniversary date for the changes to take effect.
   
• Please type or print.

Please type or print.

Please print or type.

Complete the entire form to select this option and return it with your new account application. The following restrictions apply:

• DCA Plus is not available with an Alternate Withdrawal Charge Rider
   
• DCA Plus is not available with the Extra Credit Rider.
   
• Subsequent purchase payments may be allocated to the DCA Plus Account only during the DCA Plus Period and such amounts will be transferred to the applicable investment directions over the months remaining in the DCA Plus Period.
   
• Transfers of Contract Value from the DCA Plus Account to the Fixed Account are not permitted.
   
• Transfers of Contract Value to the DCA Plus Account are not allowed.

Please type or print.

Must be accompanied by the Fund Investment Options Sheet.

Complete the entire form. Please type or print.

1. The Owner should complete this Incoming Funds Request form and any applicable state-required replacement forms.
    
2. Please contact your current carrier for any form requirements it may have for transferring money to another company.
    
3. Obtain Signature Guarantee if required by your current carrier.
    
4. This completed form and your current carrier’s form mentioned above should be mailed to the address provided below.
    
5. Upon receiving this material Security Benefit will send a letter of acceptance to the carrier.
    
6. 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.