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This form is used when the entire amount of the contract is being withdrawn/surrendered.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