Servicing Forms

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Address Change Form

This form is used when you need to make a change of address to your policy/contract. .

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

Beneficiary Changes (Annuities) Form

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

Types of Policies/Contracts: Deferred Annuities

Beneficiary Changes (Life) Form

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

Types of Policies/Contracts: Life Insurance

Direct Debit (ACH) Form

This form is used for paying premiums on your policy/contract electronically. This form authorizes ELCO to pull the premium from your checking or savings account.

Types of Policies/Contracts: Deferred Annuities Life Insurance

Direct Deposit Form

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

Types of Policies/Contracts: Deferred Annuities Immediate Annuities

*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.

IRA and Roth IRA Disclosure

This is an informational document provided by the IRS.

Types of Policies/Contracts: Deferred Annuities Immediate Annuities

Partial Withdrawal Form

Deferred Annuities, Immediate Annuities, and Life Insurance

Types of Policies/Contracts: Deferred Annuities

Periodic Withdrawal Form

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

Types of Policies/Contracts: Deferred Annuities

RMD Withdrawal Form

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

Types of Policies/Contracts: Deferred Annuities

Total Withdrawal Form

This form is used when the entire amount of the contract is being withdrawn/surrendered.

Types of Policies/Contracts: Deferred Annuities

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.