Download Forms (Members Only)

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The following forms are available for download:

General * Life Insurance * Annuities * Scholarship Program * Events * Lodge Administration

General

Form: Use this form to: Notes:
Application for Change of Address
  • Request change of address for certificates and/or payer
  • Must be signed by the insured and payer/owner
Electronic Funds Transfer (EFT) Authorization
  • 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

Form: Use this form to: Notes:
Request to Change Beneficiary (Insurance)
  • Change the beneficiary of your certificate
  • All signatures must be notarized
Request to Change Name of Insured
  • Change the name of the insured on your certificate
  • Must provide legal proof of name change as noted on the form
Request to Change Owner
  • Change the owner of your certificate
Operation/Dismemberment Claim
  • 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
Application for Cash Surrender
  • Request cash surrender of life certificates
  • Must be signed by the insured and payer/owner

Annuities

Form: Use this form to: Notes:
Annuity Disclosure
  • 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
Request to Change Beneficiary (Annuity)
  • Change the beneficiary of your certificate
  • Signature must be notarized
Request to Change Name of Annuitant
  • Change the name of the annuitant on your certificate
  • Must provide legal proof of name change as noted on the form
Annuity Withdrawal Request
  • 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

Form: Use this form to: Notes:
Scholarship Program Application
  • Includes program requirements and application form
  • Requires additional documentation
  • Subject to a submission deadline
Continuing Education Application
  • Includes program requirements and application form
  • Requires additional documentation
  • Subject to a submission deadline

Events

Form: Use this form to: Notes:
Terms and Conditions/Liability Waiver
  • 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

Form: Use this form to: Notes:
Lodge Meeting Minutes Template
  • Use this form to document the minutes of Lodge meetings
  • To be filled out by Lodge Secretary
Lodge Meeting Attendance Roster
  • Use this form to document Lodge meeting attendanace
Request for Use of LAFP Funds
  • Submit this form to request withdrawal of Lodge LAFP funds
  • Requests for funds must be submitted 10 days prior to receipt of check
LAIP Request Form
  • Submit this form to request funds from the Lodge Activity Incentive Program (LAIP)
  • To be signed by Lodge President and Secretary
Report of Newly Elected Officers
  • Submit this form within 10 days of election of Lodge Officers
  • To be signed by Lodge President and Secretary
Lodge Meeting Notification Card Template
  • 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
Lodge Supplies Order Form
  • Submit this form to request forms and/or supplies for the Lodge