Miscellaneous Forms

 

 
  The following files can be viewed using Adobe Acrobat.  To download Adobe click on link   
  http://www.adobe.com/products/acrobat/readermain.html  
     
  Many of these forms need to be notarized therefore,  please print the form and send to the home office.  

ACH Payment Form

ACH FORM.pdf This form is used to make payments automatically with your banking account or when you need to make changes on existing ACH setups.

Affidavit of Deceased Member

affidavit of deceased member.pdf This form is used in place of a lost policy when filing a death claim.

Affidavit of Lost Policy

affidavit of lost policy.pdf This form is used to receive a duplicate policy when original has been lost.

Annuity Application

annuity application.pdf This form is used to apply for an annuity.

Annuity Cash Withdrawl

annuity cash withdrawl.pdf This form is used to withdraw funds from an annuity account.

Death Benefit

death claim.pdf This form is used to file a claim of a deceased member.

Direct Deposit Enrollment

direct deposit enrollment.pdf This form is used to set up automatic deposits into your checking or savings account from your annuity/IRA.

Dividend Request Form

dividend request form.pdf This form is used to change your dividend option to cash, accumulated or to buy additional paid up insurance.

Insurance Applications

insurance application.pdf This form is used to apply for new insurance restricted to specific amounts. 

Long Form Insurance Application

insurance long form.pdf This form is used to apply for new insurance.

Medical Application Form

medical form.pdf This form is used for medical purposes when requested by the underwriter.

Membership Service Request Form

member service request form.pdf This form is used to change beneficiaries, name change, certificate loan request, policy ownership or declare a lost certificate.

Member Transfer Blanks

member transfer.pdf This form is used to transfer a member from one branch to another.

Park 2 Form

park2 4.50.pdf This form is used in conjunction with the annuity application when applying for a park 2 annuity.

1035 Exchange Form

1035exchange.pdf This form is used to transfer policies as a tax-free exchange of policies under IRC 1035(a).