Beneficiary Changes (Life) Form

How to complete the Beneficiary change form:

  1. You must print the Policy number on the top of the form.
  2. You must print the full name of each owner on the top of the form.
  3. Complete section 1 by listing your primary beneficiary or beneficiaries.
  4. Complete section 2 by listing your contingent beneficiary or beneficiaries.
  5. Section 3 requires the owner(s) to sign and date the form.

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. If you do not have a spouse, please indicate this in the “Co-owner/Spouse” space. If another person is acting as your Power of attorney (or in a similar capacity on your behalf), a copy of the legal document granting such authority must accompany this form, unless previously provided. Addition information about changing your beneficiary: · If additional space is needed, attach a separate page to this form. This page must also include the Policy number(s) affected as well as owner(s) signature(s) and date.· We recommend that you name a contingent beneficiary.  Please indicate the relationship to you.· For each “class” of beneficiary, shares must add up to 100%. For example if you list only one Primary Beneficiary, the Share would be 100%. If you list two Primary Beneficiaries, the shares could be 50% each or any percentages that add up to 100%. Specific dollar amounts are not allowed.

  • You may list “equal” in the share % section.

· To name a trust as a beneficiary, please provide a Certificate of Trust, or an abstract of the Trust agreement. Typically the declaration page and the last page of the trust document will suffice. A Minor cannot legally file a claim.  In the event you feel you must name a minor, we suggest you name a custodian. An example designation is provided below. You, would be John Doe. Jimmy Doe the minor and Jane Doe Jimmy’s mother. “Jimmy Doe, Date of Birth, if a minor at the time of death of John Doe, then his/her portion of the benefit is to be paid to Jane Doe, Custodian of Jimmy Doe, a minor beneficiary.”

  • Provide the Minor’s full name, date of birth, social security number, address, relationship to the owner, and the share of proceeds.
  • Provide any Custodian’s full name, date of birth, address, phone number, and relationship to the minor.

You may mail, fax or e-mail the completed form as follows: Mail: ELCO Mutual Life and Annuity 916 Sherwood Drive, Lake Bluff, IL, 60044Fax: (847) 295-6043E-mail: phs@elcomutual.com Please print your address, phone number and email address on the lower right hand side of the form.Failure to sign and date will necessitate a new filing. If you need any additional help or should you have any questions please contact our Policyowner Service Department Monday through Thursday between the hours of 8:00 A.M. and 4:30 P.M. and Friday between the hours of 8:00 A.M and 1:00 P.M. (Central Time). At (800) 321-3526

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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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