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Servicing Forms

The following forms can be downloaded by clicking on the corresponding link. If the form has multiple options or needs further explanation, the link will take you to a page that will explain how to complete the form. 

If you have any questions about how to fill out these forms or need any other help, please call our Policyholder Services Department at 1-800-321-3526

All forms can be sent in via fax (847) 295-6043 or by email: phs@elcomutual.com.

Address Changes

Description: This form is used when you need to make a change of address to your account.

Types of Policies/Contracts: Deferred Annuities, Immediate Annuities, and Life Insurance

Download Address Change Form


 

Direct Deposit

Description: This form is used to set up your direct deposit* and requires a voided check.

Types of Policies/Contracts: Deferred Annuities and Immediate Annuities.

Download Direct Deposit Form

*When selecting a savings account, do not use the information from a deposit slip, instead have the bank send a letter with the correct routing and account numbers.


 

Partial Withdrawals

Description: This form is used on one-time withdrawals when only a portion of the contract is being withdrawn. 

Types of Policies/Contracts: Deferred Annuities.

Download Partial Withdrawal Form


 

Periodic Withdrawals

Description: This form is used when withdrawals need to be made in increments, such as monthly interest withdrawals.

Types of Policies/Contracts: Deferred Annuities.

Download Periodic Withdrawal Form


 

RMD Withdrawals

Description: This form is used to make the Required Minimum Distribution (RMD) on qualified contracts.

Types of Policies/Contracts: Deferred Annuities.

Download RMD Withdrawal Form


 

Total Withdrawals

Description: This form is used when the entire amount of the contract is being withdrawn/surrendered.

Types of Policies/Contracts: Deferred Annuities.

Download Total Withdrawal Form


 

Beneficiary Changes (Annuities)

Description: This form is used when making a change to the beneficiary designation on your contract.

Types of Policies/Contracts: Deferred Annuities.

Download Beneficiary Change Form


 

Beneficiary Changes (Life)

Description: This form is used when making a change to the beneficiary designation on your life insurance policy.

Types of Policies/Contracts: Life Insurance.

Download Beneficiary Change Form


 

IRA and ROTH IRA Disclosure

Description: This is an informational document provided by the IRS. 

Types of Policies/Contracts: Deferred Annuities and Immediate Annuities.

Download IRA and ROTH IRA Disclosure for 2017-2018