Printable Forms Providing service to our members is a top priority at Modern Woodmen of America. If you would like to use one of our service forms below, please print, complete and send the form to our headquarters using a method described on the instruction page included with the form. Confirmation of the change will be mailed to the owner of the certificate once the request has been processed by our headquarters. To download the form, click on the form title. If you cannot find the form you need below, please contact your Modern Woodmen representative or our Service Center at 800-447-9811, Monday through Friday, 8 a.m. to 4:30 p.m. (Central). Need Help? Contact our headquarters Talk to your financial representative. FAQ Member Benefits Payment Options Printable Forms Automatic bank check plan (ABC) authorization This is a convenient and safe way to make a payment. The Automatic Bank Check Plan may be used to automatically pay your premiums or loan repayments on a monthly basis from a checking or savings account. Absolute assignment form An absolute assignment is a transfer of all ownership rights of an insurance or nonqualified annuity certificate from one individual to another individual or entity. To assign a certificate, this form needs to be signed, dated, properly notarized and submitted to our headquarters. Applicant change form An applicant is the owner of a certificate in which the insured was 15 years old or younger at the time of the original issue. This form allows for the current applicant to be changed to another individual. The insured must be under age 21. Beneficiary and/or name change form This form allows for the change of the beneficiary on a certificate as well as the name of the insured or applicant on a life or annuity certificate. This form is in a fillable format, but must be printed, signed and mailed to our headquarters. Collateral assignment form Collateral assignment is a transfer of certain ownership rights of an insurance or annuity certificate to the applicant's creditor as security for payment of a debt. To assign a certificate, this form needs to be signed, dated, properly notarized and submitted to our headquarters. Fraternal Aid Fund application – natural disaster If you are a Modern Woodmen member and have experienced a financial setback due to your health, or major damage to your home or business as a result of a fire, flood or natural disaster, Modern Woodmen's Fraternal Aid Fund may offer financial relief from your premium payments for a limited time. Fraternal Aid Fund application – illness/injury If you are a Modern Woodmen member and have experienced a major financial setback due to your health, Modern Woodmen's Fraternal Aid Fund may offer financial relief from your premium payments for a limited time. Release of control to the insured on a junior certificate An applicant is the owner of a certificate in which the insured was 15 years old or younger at the time of the original issue. This form allows for the current applicant to give control to the insured as long as the insured is now 16 years of age. Note: More forms are available on the member website. (Login required.) Let's plan together for ... Life's moments Protection Savings Retirement planning Retirement distribution Estate planning Business planning Employee benefits Life's moments Select a financial goal from the drop-down menu to find helpful tips and articles. Your financial representative Meet a Modern Woodmen representative in your community and begin to explore how shared values can work for you. Find a rep near you Connect with us Need help? Contact us Phone: 309-558-3077 or 800-447-9811 Member login How we use your information Notice of collection for California residents Looking for a meaningful career? Grow with Modern Woodmen! As a financial representative, you can make a positive impact for your family and your community. Learn more © 2021 Modern Woodmen of America. All Rights Reserved. Terms of Use | Your Privacy | ONLINE PRIVACY POLICY How We Use Your Information Notice of Collection for California Residents MWA Financial Services Inc. Securities offered through MWA Financial Services Inc., a wholly owned subsidiary of Modern Woodmen of America, 1701 1st Avenue, Rock Island, IL 61201, 309-558-3100. Member: FINRA (opens in new tab), SIPC (opens in new tab). Check the background on either the firm or the representative on FINRA's BrokerCheck (opens in new tab). For more information, see the MWAFS Best Interest page. Products are available in most states. Individual representatives may not be licensed to sell all products.