Authorization to release information form
This form allows Modern Woodmen to release information concerning the designated certificate(s) to an authorized party, though the authorized party is not permitted to make transactions on the certificate.
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.
Fraternal Aid Fund extension application
Members can apply for the Fraternal Aid Fund benefit a second time within a five-year period by completing a Fraternal Aid Fund extension application. You must provide supporting documents that show the out-of-pocket expenses you have incurred since the last time Fraternal Aid was granted. Please provide enough documentation to substantiate financial hardship.
National Parks Pass reimbursement form
Print, complete and mail the reimbursement form to receive a $5 reimbursement of fees associated with the America the Beautiful Parks and Federal Recreational Lands Lifetime Senior Pass ($80) or Annual Senior Pass ($20). Each pass is available to U.S. citizens or permanent residents age 62 or older.
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.
Request to discontinue premium notices form
This form must be signed by the certificate owner to discontinue mailed premium notices.