Security Benefit

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Variflex® Variable Annuity Forms

For help on filling out the forms, please view the form completion instructions.

Form Description
Annuitization
Use this form to begin annuity payments.
Annuity Loan Application and Agreement
Use this form to establish a loan on your account.
Asset Reallocation Use this form to automatically transfer account values to maintain a specific percentage allocation among your current and future investment options.
Change Investment Allocation Use this form to modify your existing and/or future investment allocations. This includs a one time re-balance and/or a transfer of Contract Value between investment options.
Collateral Assignment 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.
Electronic Authorization Use this form to activate electronic services such as telephone authorization. This authorization allows you to submit a one time re-balance, an exchange between funds, change your future allocation and make address changes via the telephone.
Electronic Bank Information
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 Security Benefit.
Internal Exchange Statement and Agreement
Use this form to transfer funds internally from one account to another.
Limited Power of Attorney This form gives authority to another person ("attorney in fact") to act on your behalf for the Contract/Account Number identified.
Non-Financial Change
(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 chan
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.
Required Minimum Distribution The Internal Revenue Service ("IRS") requires individuals to begin receiving a Required Minimum Distribution ("RMD") from qualified accounts(s) at 70 1/2. Upon attaining this age, it is your responsibility to request these distributions. Use this form to request an RMD.
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 Withdrawals Use this form to establish or change a Scheduled Systematic Withdrawal (SSW) from your account.
Stretch IRA Beneficiary Designation Use this form to extend the duration of beneficiary distributions to the beneficiaries you designate.
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.

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Services are offered through and securities distributed by Security Distributors, a subsidiary of Security Benefit Corporation (Security Benefit).

Security Benefit is a leading provider of retirement plan services throughout the nation, primarily in the education marketplace. Security Benefit offers trust account programs under 401(k) and 401(a) and under §401 of the Internal Revenue Code; voluntary custodial accounts under 403(b)(7) ERISA and 403(b)(7) of the Internal Revenue Code; §457 Governmental Programs; and trust account Top Hat programs under §457(g) of the Internal Revenue Code; and Voluntary Employees' Beneficiary Association (VEBA) trust programs qualified under Section 501(c)(9) of the Internal Revenue Code.

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