Servicing Forms

Address Change Form Image

Address Change Form

Description: 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, and Life Insurance.


Partial Withdrawal Form Image

Partial Withdrawal Form

Description: Deferred Annuities, Immediate Annuities, and Life Insurance

Types of Policies/Contracts: Deferred Annuities.


Direct Deposit Form Image

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.

*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 Image

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.


RMD Withdrawal Form Image

RMD Withdrawal Form

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

Types of Policies/Contracts: Deferred Annuities.


Total Withdrawal Form Image

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Description: This form is used when the entire amount of the contract is being withdrawn/surrendered.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


Beneficiary Changes (Annuities) Form Image

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.


Beneficiary Changes (Life) Form Image

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.


IRA and Roth IRA Disclosure Image

IRA and Roth IRA Disclosure

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

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


Direct Debit (ACH) Form Image

Direct Debit (ACH) Form

Description: 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, and Life Insurance.


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.

WP-00004