AdvisorDesigns is no longer offered for sale. The information provided here is solely for the use of existing contract holders.


AdvisorDesigns Variable Annuity Forms
For help on filling out the forms, please view the instructions.


Use this form to begin annuity payments.

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 includes a one time re-balance and/or a transfer of Contract Value between investment options.

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.

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 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 Insurance and Annuity Company of New York.

Information Authorization

For replacing an existing life insurance policy or annuity contract with a First Security Benefit Life Insurance product.

Internal Exchange Statement & Agreement

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

Investment Advisor Authorization

Use this form to establish authority for your investment advisor.

Non-Financial Change

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.

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

To add or change Required Minimum Distribution options, contact your Advisor or our Service Center (800.888.2461) to request a form.

Restricted Beneficiary Designation

This form should be used if you wish to place restrictions on the payout of your death benefit to your beneficiaries. This Beneficiary Designation supersedes any and all previous Beneficiary designations. FSBL suggests that you keep a copy of this 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 Withdrawals

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

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.

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.


Form Completion Instructions
Please review these instructions prior to completing any of the forms online. The majority of our forms are designed in a fillable format so you may enter the required information online. If you experience problems and need assistance, please call our Service Center at 800.888.2461.

  • Select the form you wish to complete.
  • Enter the information into the fillable fields.
  • Save the form in a desired location on your computer.
  • Print a copy of the form.
  • Make sure you obtain all applicable signatures.
  • Return the form to First Security Benefit Life for processing. You may mail or fax the form.

First Security Benefit Life Administrative Office
P.O. Box 750497
Topeka, KS 66675-0497
Fax to: 785.368.1772

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Plan for Retirement With One of Our Annuities

Whether you’re searching for options to save enough for retirement or to ensure your savings last long enough in retirement, First Security Benefit Life can help.

Explore Our Annuities

Annuities are long-term investments suitable for retirement investing. All guarantees provided in an annuity are subject to the claims-paying ability of the issuing insurer.

Annuities are not insured by the FDIC or otherwise insured or guaranteed by the Federal government or any of its agencies. They are not obligations of, or guaranteed by, any bank, savings and loan or credit union.

The investment return and principal value of an investment in variable annuities will fluctuate and you may have a gain or loss at redemption.

You should carefully consider the investment objectives, risks, and charges and expenses of the variable annuity and its underlying investment options before investing. You may obtain a prospectus for the variable annuity and prospectuses or summary prospectuses (if available) for the underlying investment options by calling our Service Center at 1-800-888-2461. You should read the prospectuses carefully before investing. Investing in variable annuities involves risk and there is no guarantee of investment results.

Annuities are issued by First Security Benefit Life Insurance and Annuity Company of New York (FSBL), Albany, NY. Variable annuities are distributed by Security Distributors, an affiliate of FSBL. AdvisorDesigns® (NY) (form FSB216 (10-01)) is a flexible premium deferred variable annuity issued by FSBL.

Neither FSBL nor Security Distributors is a fiduciary and the information provided is not intended to be investment advice. This information is general in nature and intended for use with the general public. For additional information, including any specific advice or recommendations, please visit with your financial professional.