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 explaining how to complete the form.

Address Change Form

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.

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Partial Withdrawal Form

Description: Deferred Annuities, Immediate Annuities, and Life Insurance

Types of Policies/Contracts: Deferred Annuities.

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Direct Deposit Form

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.

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*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.


Periodic Withdrawal Form

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

Types of Policies/Contracts: Deferred Annuities.

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RMD Withdrawal Form

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

Types of Policies/Contracts: Deferred Annuities.

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Total Withdrawal Form

Description: This form is used when the entire amount of the contract is being withdrawn/surrendered.

Types of Policies/Contracts: Deferred Annuities.

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Beneficiary Changes (Annuities) Form

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

Types of Policies/Contracts: Deferred Annuities.

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Beneficiary Changes (Life) Form

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

Types of Policies/Contracts: Life Insurance.

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IRA and Roth IRA Disclosure

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

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

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Need General Assistance?

If you have questions about how to fill out these forms or need any other help, please call our policy services department at 1-800-321-3526.  All forms can be sent in via fax to (847) 295-6043 or by email to phs@elcomutual.com. If you'd like to be contacted by ELCO, please fill out the form below.

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