CO Agent Forms

Agent Forms Home   |    All Forms  |   Frequently Asked Questions

Application

ACH Authorization Request

Authorization for direct deposit of checks.
States:
CO, IL, IA, MD, MO, PA, TX, WV, WI

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ACH Automatic Premium Payment

Authorization to deduct the monthly payments direct from checking acoount.


States:
CO, IL, IA, MO, PA, TX, WV, WI

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Additional Beneficiary form

To be used to name multiple beneficiaries to be included with the application.


States:
CO, IL, IA, MD, MO, PA, TX, WV, WI

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Guarantee Issued Whole Life - Graded Benefit

Application for Guaranteed issue certificate.
States:
CO, IL, IA, MD, MO, PA, TX, WV, WI

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HIPPA Authorization Form

Include with all life insurance applications.
States:
CO, IL, IA, MD, MO, PA, TX, WV, WI

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INSTRUCTION FORMS FOR THE COMPLETION OF REPLACEMENT FORM

FOR USE WITH LIFE AND ANNUITY REPLACEMENT FORMS
States:
CO, IL, IA, MD, MO, PA, TX, WV, WI

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Juvenile Life Application

Application for life insurance coverage for child age 0-15.
States:
CO, IL, IA, MD, MO, TX, WV, WI

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Life Insurance Application

Application for life insurance age 15 and over.
States:
CO, IL, IA, MD, MO, TX, WV

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Life insurance application and related forms.

Life application and related forms except transfers and replacement forms.
States:
CO, IL, IA, MO, TX, WV

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Life Insurance Application Supplement

Supplemental form to include spouse and child term riders to the base policy.


States:
CO, IL, IA, MD, MO, PA, TX, WV, WI

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Ownership Agreement Form

To be signed when changing joint owners to single owner.
States:
CO, IL, IA, MD, MO, PA, TX, WV, WI

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Receipt

Receipts for advance payments on Life and annuity applications
States:
CO, IL, IA, MD, MO, PA, TX, WV, WI

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REPLACEMENT COMPARISON SHEET - ALL REPLACEMENTS

REPLACEMENT COMPARISON SHEET THAT MUST BE SUBMITTED WITH EACH REPLACEMENT CASE, LIFE AND ANNUITY
States:
CO, IL, IA, MD, MO, PA, TX, WV, WI

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Senior Annuity Suitability Form

For customers 65 & older.
States:
CO, IL, IA, MD, PA, TX, WV, WI

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Transfer Request Annuities & Life Insurance

Authorization to transfer funds.

States:
CO, IL, IA, MD, MO, PA, TX, WV, WI

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Withholding Form - W-4P

Withholding certificate for pension or annuity payments.

States:
CO, IL, IA, MD, MO, PA, TX, WV, WI

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Service

ACH Form/Automatic Premium Payment

Authorization for the deduction of premium payments from checking accounts.
States:
CO, IL, IA, MD, MO, PA, TX, WV, WI

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Application For Reinstatement

Application to be completed when a premium payment has gone beyond the 30 day grace period.
States:
CO, IL, IA, MD, MO, PA, TX, WV, WI

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Automatic Annuity Withdraws

Scheduled annuity withdrawals.
States:
CO, IL, IA, MD, MO, PA, TX, WV, WI

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Automatic Premium Payments Plan

Authorization for automatice premium payment.
States:
CO, IL, IA, MD, MO, PA, TX, WV, WI

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Billing/Disbursements Election

billing changes etc.

States:
CO, IL, IA, MD, MO, PA, TX, WV, WI

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Change of ownership - life policies only


States:
CO, IL, IA, MD, MO, OH, PA, PR, TX, WV, WI

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Full or Partial Surrender

Full or partial cash surrender request.
States:
CO, IL, IA, MD, MO, PA, TX, WV, WI

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Representatives Electronic Funds Transfer Authorization Form

Payroll form for representatives to have their paychecks deposited electronically.


States:
CO, IL, IA, MD, MO, PA, TX, WV, WI

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Service Request/Beneficiary Change

Request for to change the beneficiary designation.
States:
CO, IL, IA, MD, MO, PA, TX, WV, WI
States:
AL, AK, AZ, AR, CA, CO, CT, DE, DC, FL, GA, GU, HI, ID, IL, IN, IA, KS, KY, LA, ME, MH, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC, ND, OH, OK, OR, PW, PA, PR, RI, SC, SD, TN, TX, UT, VT, VI, VA, WA, WV, WI, WY

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Brochures

1-10 Year Annuity Rates


States:
CO, IL, IA, MD, MO, PA, TX, WV, WI

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Need a Gift for a Child?


States:
CO, IL, IA, MD, MO, PA, TX, WV, WI

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WCU Financial Summary

March 12, 2008
States:
CO, IL, IA, MD, MO, PA, TX, WV, WI

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Whole Life Brochure


States:
CO, IL, IA, MD, MO, PA, TX, WV, WI

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Software Downloads

WCU Software


States:
CO, IL, IA, MD, MO, PA, TX, WV, WI

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