State Replacement Forms

• Security Benefit Life Replacement Policy

When replacing another insurer's contract, be certain you are obtaining all the appropriate forms. Please send the original copy of the state replacement form to Security Benefit, provide the applicant with a copy and retain a copy for the agent file.

• Sales Literature Confirmation

(Required on replacement cases for AK, AL, AR, AZ, CO, CT, FL, HI, IA, IN, KS, KY, LA, MD, ME, MO, MS, MT, NC, NE, NH, NJ, NM, NV, OH, OK, OR, RI, SC, TX, UT, VA, VT, WI, WV)

• Multi-state Replacement Form

(AK, AL, AZ, CO, CT, HI, IA, KY, LA, MD, ME, MO, MS, MT, NC, NE, NH, NJ, NM, OH, OR, RI, SC, SD, TX, UT, VA, VT, WI, WV)

PDFs of State Replacement Forms

*Requires completion of all the forms listed for the state.

• Arkansas*
  
  
  Sales Literature Confirmation
  Multi-state Replacement Form
  
  

• California
  
  CA Residents Age 65 or Older (Notice of Tax Consequences)
  Notice to Seniors Regarding Insurance Sales Meeting (In Home Notice)
  
  

• Delaware

• Florida
  
  Florida Comparative Information Form
  Annuity Suitability Questionnaire 
  Disclosure and Comparison of Annuity Contracts
  
  

• Georgia

• Idaho

• Illinois
  
  Illinois Notice to Applicant
  
  

• Indiana

• Kansas existing policy issued by another company
  
  Kansas existing policy issued by SBL
  
  

• Massachusetts

• Minnesota

• Nevada
  
  Nevada Comparative Information Statement
  
  

• North Carolina*(Suitability Questionnaire)
  
  NC also requires Multi-state Replacement form
  
  

• Oklahoma Notice to Applicant*
  
  Oklahoma Statement by Applicant
  
  

• Pennsylvania

• Tennessee

• Washington

• Wyoming