Annuitization Use this form to begin annuity payments.

Annuity Loan Application and Agreement Use this form to establish a loan on your account.

Collateral Assignment Use this form to assign a Non-Qualified Contract/Policy (the "Contract") as collateral.

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.

Electronic Authorization Use this form to activate electronic services such as telephone authorization.

Electronic Bank Info Use this form to activate or update electronic bank deposits/withdrawals.

Information Authorization 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.

Non-Financial Change (Change to name, address, beneficiary, etc.) 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.

One-Time Withdrawal 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 Financial Representative 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.

Scheduled Systematic Withdrawal To add or change Scheduled Systematic Withdrawal options, contact your Financial Representative or our Service Center (800.888.2461) to request a form.

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