Address Change Form

How to complete the address change form:Print the Contract number on the top of the form.Print the full name of each owner on the top of the form.Failure to print the full name of each owner and contract number on the form will void the form.

  1. Complete section 1 by stating New address.
  2. Complete section 2a by stating when you wish your address to change.  If you do not mark anything the change will happen immediately. 

Complete section 2b If you have any additional instructions.

  1. Complete section 3 by each owner signing their name and date.

If you have a co-owner or spouse please have them sign and date if applicable.If you reside in one of the following Community Property States of AZ, CA, ID, LA, NV, NM, TX, WA, or WI your spouse must also sign the form.Where the owner is a person acting as guardian, conservator or in a similar capacity, evidence of that appointment must accompany this form, unless already provided in writing.Failure to sign and date will void the form. Complete the Address Change Form and send to ELCO in any of the following methods:ELCO Mutual Life and Annuity 916 Sherwood Drive Lake Bluff IL, 60044Fax to (847) 295-6043Scan and Email to: phs@elcomutual.com

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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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