Use this form to begin annuity payments.
Annuity Loan Application and Agreement
Use this form to establish a loan on your account.
Use this form to automatically transfer contract values to maintain a specific percentage allocation among your current and future investment options.
CARES Act Annuity Request Form
The CARES Act was signed into law on March 27, 2020 to help provide economic relief to individuals impacted by the COVID-19 outbreak.
Change Investment Allocation
Use this form to modify your existing and/or future investment allocations. This includes a one-time re-balance and/or a transfer of Contract Value between investment options.
Use this form to assign a Non-Qualified Contract/Policy (the "Contract") as collateral.
Dollar Cost Averaging
Use this form to request periodic exchanges from one investment option to one or more investment options.
Domestic Violence Confidential Communication
Form for victims of domestic violence in New York to submit a valid order of protection and request a confidential alternative means of communication. Use this form to provide an alternative address, telephone number or other method of contact.
Use this form to activate electronic services such as telephone authorization.
Electric Bank Info
Use this form to activate or update electronic bank deposits/withdrawals.
Incoming Funds Transfer-Rollover
Use this form to transfer funds from your current carrier to First Security Benefit Life.
For replacing an existing life insurance policy or annuity contract with a First Security Benefit Life product.
Internal Exchange Statement and Agreement
Use this form to transfer funds internally from one account to another.
Investment Advisor Authorization
Use this form to establish authority of your investment advisor.
Use this form to modify or change information regarding the roles on your account: Owner, Joint Owner, Annuitant and/or Beneficiary name and/or address change.
To make a one-time withdrawal from your account, please contact your Financial Representative or our Service Center (800.888.2461) to request a form.
Proof of Death
This form is to be completed in order to claim proceeds payable upon death. A separate Proof of Death from should be completed and signed by each beneficiary.
Required Minimum Distribution
To add or change Required Minimum Distribution options, contact your Advisor or our Service Center (800.888.2461) to request a form.
Salary Reduction Agreement
Use this Form to set up contributions to your 457 or Tax Sheltered account from your paycheck. Please check with your employer to verify that this agreement meets your employer's requirements.
Schedule System Systematic Withdrawal
To add or change Scheduled Systematic Withdrawal options, contact your Advisor or our Service Center (800.888.2461) to request a form.
Suitability and Best Interest Certification
Use this form to show that there is a reasonable basis for believing that the purchase suits your current investment goals and financial situation, and that you have been reasonably informed of the terms and features of a variable annuity and would benefit from certain features of a variable annuity.
Surrender Charge Waiver
This form must accompany each withdrawal requested under the Surrender Charge Waiver option. Certify your reason for waiver and have your physician complete and sign the Physician's Signature Section.