Service Forms

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 Reallocation Request - Strategic Growth Series

This form is for use with Strategic Growth, Strategic Growth Plus, and Strategic Growth 7 contracts issued without the Rate Buy Up feature.

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.

This form is for use with Strategic Growth, Strategic Growth Plus, and Strategic Growth 7 contracts issued with the Rate Buy Up feature.

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.

Account Value Reallocation Request - TVA

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

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.

Internal Exchange Statement Agreement

Use this form to transfer funds internally from one account to another.

Large Case Review Form

Use this form for any purchase, or combined purchases, greater than the premium amounts indicated below. For age-based determinations, approvals are based on the client’s age at issue. Purchases below these amounts do not need this form.

For cases exceeding these amounts, submit the large case review form for pre-approval. For the review, the client signature can be left blank. Following pre-approval, the form must be signed by the Owner (and Joint Owner where applicable) and submitted with the client application. 

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.

Non-Resident Sales Guide and Video Conferencing Policy

Use this guide as a reference for non-resident annuity sales.

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.

Per Stirpes Designation

This form is to be completed when an applicant wishes to identify a beneficiary with a per stirpes designation. 

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.

Statement of Understanding - Strategic Growth Annuity

It is important for the applicant to read this summary before deciding to purchase the annuity. This summary will help understand the features of the annuity and determine if it will help meet your client's financial goals. Once he/she has read this summary, make sure he/she signs the last page to confirm understanding of the annuity and submit this document with his/her application for the annuity and the Annuity Suitability form.

Statement of Understanding - Strategic Growth Plus Annuity

It is important for the applicant to read this summary before deciding to purchase the annuity. This summary will help understand the features of the annuity and determine if it will help meet your client's financial goals. Once he/she has read this summary, make sure he/she signs the last page to confirm understanding of the annuity and submit this document with his/her application for the annuity and the Annuity Suitability form.

Statement of Understanding - Strategic Growth 7 Annuity

It is important for the applicant to read this summary before deciding to purchase the annuity. This summary will help understand the features of the annuity and determine if it will help meet your client's financial goals. Once he/she has read this summary, make sure he/she signs the last page to confirm understanding of the annuity and submit this document with his/her application for the annuity and the Annuity Suitability form.

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.