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.

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.

Branch Announcement Form

 branch form.pdf This form is used for branch announcements.

Credit Card Payment

 credit card payment.pdf This form is used to make premium payments with a credit card.

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. 

IRA Transfer Form

 IRA transfer.pdf This form is used to transfer an IRA. 

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
(2 page document)		 This form is used to declare a lost certificate, request a loan, surrender a policy for its cash value, change ownership, change the beneficiary or change the insured's name.

Member Transfer Blanks

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

Preauthorized Charge Authorization (P.A.C)

 PAC FORM.pdf This form is used to set up debits automatically from your checking or savings account to your Annuity or IRA.

Park 2 Form

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

Replacement Notice Form

 Replacement Notice.pdf This form is used when replacing an existing life insurance or annuity coverage in connection with the purchase of our life insurance or annuity coverage.

1035 Exchange Form

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

3 Year Payment Plan Loan Form

 3 yr payment plan.pdf This form is used for a 3 tier payment plan on a Single Premium Policy.