General
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Form:
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Use this form to:
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Notes:
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Application for Change of Address
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- Request change of address for certificates and/or payer
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- Must be signed by the insured and payer/owner
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Electronic Funds Transfer (EFT) Authorization
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- Authorize electronic funds transfer to pay your life premiums, annuity deposits, or mortgage payment to WSA
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- Include a voided blank check or deposit slip showing your pre-printed routing transit number and bank codes.
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Life Insurance
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Form:
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Use this form to:
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Notes:
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Request to Change Beneficiary (Insurance)
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- Change the beneficiary of your certificate
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- All signatures must be notarized
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Request to Change Name of Insured
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- Change the name of the insured on your certificate
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- Must provide legal proof of name change as noted on the form
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Request to Change Owner
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- Change the owner of your certificate
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Operation/Dismemberment Claim
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- Request and document Operation and/or Dismemberment benefit claims
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- Must be completed and signed by the Physician or Surgeon, or:
- Accompanied by billing information adequate to support claim
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Application for Cash Surrender
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- Request cash surrender of life certificates
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- Must be signed by the insured and payer/owner
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Annuities
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Form:
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Use this form to:
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Notes:
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Annuity Disclosure
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- Describes important facts and features of a WSA deferred annuity
- Includes interest rates, surrender charges and taxes on withdrawals
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- Please read this document if you own a WSA deferred annuity or are considering applying for one
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Request to Change Beneficiary (Annuity)
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- Change the beneficiary of your certificate
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- Signature must be notarized
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Request to Change Name of Annuitant
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- Change the name of the annuitant on your certificate
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- Must provide legal proof of name change as noted on the form
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Annuity Withdrawal Request
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- Request a withdrawal of funds from an annuity
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- Must be signed by the owner of the annuity
- Includes a copy of IRS Form W-4P, which must also be completed
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Scholarship Program
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Form:
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Use this form to:
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Notes:
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Scholarship Program Application
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- Includes program requirements and application form
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- Requires additional documentation
- Subject to a submission deadline
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Continuing Education Application
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- Includes program requirements and application form
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- Requires additional documentation
- Subject to a submission deadline
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Events
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Form:
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Use this form to:
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Notes:
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Terms and Conditions/Liability Waiver
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- You must sign and return this form prior to participating in any WSA sponsored event
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- Requires parent signature for participants under 18 years of age
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Lodge Administration
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Form:
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Use this form to:
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Notes:
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Lodge Meeting Minutes Template
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- Use this form to document the minutes of Lodge meetings
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- To be filled out by Lodge Secretary
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Lodge Meeting Attendance Roster
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- Use this form to document Lodge meeting attendanace
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Request for Use of LAFP Funds
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- Submit this form to request withdrawal of Lodge LAFP funds
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- Requests for funds must be submitted 10 days prior to receipt of check
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LAIP Request Form
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- Submit this form to request funds from the Lodge Activity Incentive Program (LAIP)
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- To be signed by Lodge President and Secretary
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Report of Newly Elected Officers
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- Submit this form within 10 days of election of Lodge Officers
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- To be signed by Lodge President and Secretary
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Lodge Meeting Notification Card Template
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- Submit this form before Lodge meetings in order for the Home Office to mail notification cards to members
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- Must be received no later than 20 days before meeting date
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Lodge Supplies Order Form
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- Submit this form to request forms and/or supplies for the Lodge
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