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Printable Forms
Servicing our members is the top priority at Modern Woodmen of America.  If you would like to use one of our service forms below, please print, complete and send it to the home office, 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 the home office.

To download the form, please click on the form title or the PDF icon.  If you cannot find the form you need below, please contact your representative or the home office Service Center at (800) 447-9811, M-F, 8 a.m. - 4:30 p.m., Central Time.

Automatic Bank Check Plan (ABC) AuthorizationPDF(43.7k)
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 FormPDF(38.1k)
An absolute assignment is a transfer of all ownership rights of an insurance or non-qualified annuity certificate from one individual to another individual or entity.  In order to assign a certificate, this form needs to be signed, dated, properly notarized and submitted to the home office.

Applicant Change FormPDF(60.6k)
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 the age of 21 (16 in New York). 

Beneficiary and/or Name Change FormPDF(50.5k)
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 the home office. 

Collateral Assignment FormPDF(34.3k)
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.  In order to assign a certificate, this form needs to be signed, dated, properly notarized and submitted to the home office.

Direct Deposit of IRS Tax Refund to an IRADirect Deposit Form(44.0k)
Modern Woodmen members have the ability to request the Internal Revenue Service (IRS) to directly deposit all or part of their federal income tax refund into their Modern Woodmen Traditional IRA and/or Roth IRA subject to tax year contribution limits.

Fraternal Aid Fund Application - Natural Disaster  (44.0k)
If you are a Modern Woodmen member and you have experienced 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 - Health/Accident  (52.0k)
If you are a Modern Woodmen member and you 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. 

Loan Agreement (35.0k)
As an alternative to cash surrendering a certificate, this form can be completed by the certificate owner to request a loan against any portion of the available loan value in the contract.  This form needs to be signed, dated and submitted to the home office.

Release of Control to the Insured on a Junior CertificatePDF(34.0k)
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.



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