Service Center
Our Member Service Representatives are committed to providing quality service to our membership. See answers to the most frequently asked service questions. If you have additional questions or service requests that can not be answered through the following Member Service Forms and Instructions, please contact our Home Office.
Below are basic service forms and instructions that you can download and print using Adobe Reader. If you do not already have Adobe Reader, please click the following button to get your free copy:
| Member Service Forms & Instructions | ★ Mail original form to Home Office |
|---|---|
| Affidavit of Lost Certificate (A-40) ★ | May be required if the original certificate is not returned with a surrender request. |
| Application for Change of Beneficiary (A-15) ★ | Designate individual(s) who will receive death benefits from your certificate. |
| Application for Change of Beneficiary Trust (A-15T) ★ | Designate a Trust as your Primary Beneficiary. |
| Application for Change of Beneficiary Trust (A-15TC) ★ | Designate a Trust as your Contingent Beneficiary. |
| Application for Good Health Benefits (C-109) | Application for Good Health Benefits (C-109) |
| Application for Scholarship Benefit - Based on Financial Need (C-77) ★ | For more details see our Scholarship Opportunity page. |
| Application for Scholarship Benefit - Based on Merit (C-75) ★ | For more details see our Scholarship Opportunity page. |
| Attorney Appointment Affidavit (A-27) ★ | Verify that your Power of Attorney is still valid. |
| Authorization for Release of Information (A-22) | Give us permission to discuss your certificate with a third party. |
| Claim for Death Benefit Instructions (I-100i), Form (I-100), & Settlement Options (I-100n) ★ | Inform us of the death of a member and make a claim for the proceeds of the certificate. Each beneficiary must complete a claim form. Note: If reporting the death of an annuity or IRA certificate holder, additional forms are required and special options are available for spouse beneficiaries. Also, if a trust or an estate is the named beneficiary, please contact us for additional instructions. |
| Direct Deposit Authorization Agreement (I-621) ★ | Request that regular payments be made from us directly to your bank account (not available for a single sum payment, e.g. lump sum death claim payment). |
| Existing Certificate 1035 Exchange Form (A-1035 E ExistCert) ★ | For a beneficiary, spouse and non-spouse, to exchange all or part of non-qualified annuity assets into an existing Woman’s Life non-qualified annuity in their own name. |
| Express Claims Funeral Home Verification (I-100e) ★ | May be used in some cases for death claims as an alternative proof of death. |
| Help Us Keep Track of Your Address (O-316) | Authorize us to contact a friend or relative to obtain your current address. |
| Making additional contributions into Your FPDA (F-579) ★ | Make additional contributions to your annuities. |
| Passcode Authorization A-92 ★ | A-92 Passcode Authorization form |
| Passcode Removal Authorization A-92R ★ | A-92R Passcode Removal Authorization |
| Request for Automatic Bank Draft Plan (F-202) | Establish automatic monthly premium payments from your bank account. |
| Request for Change in Dividend Option - Release of Dividends (A-12) ★ | Make a change to your dividend option or make a withdrawal of dividends. |
| Request for Taxpayer Identification Number and Certification (W-9) ★ | Confirm your social security number. |
| Secondary Addressee Designation (A1-SEC ADD) | Add/change/remove another person or third party who will receive lapse and/or termination notices due to non-payment of premium to prevent unintended lapse or termination of coverage. |
| Withholding Notice and Election Non-Periodic Payment or Withdrawals from Annuities & IRAs (I-536) ★ | Elect or opt-out of Federal Withholding from annuity distributions, including death claims. |
Please mail completed, signed forms along with any other required documents to:
Woman’s Life Insurance Society®
A Fraternal Benefit Society
1338 Military Street
PO Box 5020
Port Huron,
MI
48061-5020
US
| Electronic Signature Forms & Instructions | |
|---|---|
 I-621c Direct Deposit Authorization Agreement |
Click on the link. Each beneficiary should complete the Direct Deposit Authorization Agreement only if direct deposit of claim proceeds is preferred. This will take you to DocuSign for Electronic Signature. |
