FIXED ANNUITY

For annuitizing your contract, designating Annuity Life and Non-Life options and Secondary Payee information. Select your investment basis, method and frequency of the payout, and tax withholding information.

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

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. 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.

For establishing the privilege to have payments made from your First Security Benefit Life Contract directly to your Bank Account. This form works similar to the Electronic Funds Transfer form, it enables you to transfer funds electronically.

For transferring assets from your Current Carrier to a First Security Benefit Life Annuity Contract.

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

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.

For changing the name and/or address of the existing Annuitant/Participant, Beneficiary(ies), Owner, or Joint Owner of the Contract.

For selecting how to handle proceeds, applying to receive payments electronically via Electronic Funds Transfer (EFT), and selecting Federal income tax options. Note: Every beneficiary is required to complete his or her own form in the case of a death benefit.

Use this form to indicate the guarantee period for a new allocation or to select the new guarantee period for reallocations.

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

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

For establishing privileges to withdraw funds from your contract without incurring a surrender penalty. Must meet requirements outlined on the form and in your contract. This form must accompany any withdrawal form requested under the Hospital/Nursing Home Waiver Option.

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