General

• Request change of address for certificates and/or payer

• Must be signed by the insured and payer/owner

• Authorize electronic funds transfer to pay your life premiums, annuity deposits, or mortgage payment to WSA

• Include a voided blank check or deposit slip showing your pre-printed routing transit number and bank codes.

Life Insurance

• Change the beneficiary of your certificate

• All signatures must be notarized

• Change the name of the insured on your certificate

• Must provide legal proof of name change as noted on the form

• Change the owner of your certificate

• Request and document Operation and/or Dismemberment benefit claims

• Must be completed and signed by the Physician or Surgeon, or:
• Accompanied by billing information adequate to support claim

• Request cash surrender of life certificates

• Must be signed by the insured and payer/owner

Annuities

• Describes important facts and features of a WSA deferred annuity
• Includes interest rates, surrender charges and taxes on withdrawals

• Please read this document if you own a WSA deferred annuity or are considering applying for one

• Change the beneficiary of your certificate

• Signature must be notarized

• Change the name of the annuitant on your certificate

• Must provide legal proof of name change as noted on the form

• Request a withdrawal of funds from an annuity

• Must be signed by the owner of the annuity
• Includes a copy of IRS Form W-4P, which must also be completed

Scholarship Program

• Includes program requirements and application form

• Requires additional documentation
• Subject to a submission deadline

• Includes program requirements and application form

• Requires additional documentation
• Subject to a submission deadline

Events

• You must sign and return this form prior to participating in any WSA sponsored event

• Requires parent signature for participants under 18 years of age

Lodge Administration

• Use this form to document the minutes of Lodge meetings

• To be filled out by Lodge Secretary

• Use this form to document Lodge meeting attendanace

• Submit this form to request withdrawal of Lodge LAFP funds

• Requests for funds must be submitted 10 days prior to receipt of check

• Submit this form to request funds from the Lodge Activity Incentive Program (LAIP)

• To be signed by Lodge President and Secretary

• Submit this form within 10 days of election of Lodge Officers

• To be signed by Lodge President and Secretary

• Submit this form before Lodge meetings in order for the Home Office to mail notification cards to members

• Must be received no later than 20 days before meeting date

• Submit this form to request forms and/or supplies for the Lodge